The use of curved vs. straight instruments in single port access surgery, on standardized box trainer tasks

Abstract

BackgroundSingle-port access (SPA) surgery is a novel surgical technique to create nearly “scarless” surgery. SPA surgery appears to be safe and feasible, but the exposure and handling of tissue may not be optimal. Therefore, the performance of SPA surgery with different instruments used and conventional laparoscopy is compared.MethodsFifteen participants (>50 laparoscopic procedures) performed three basic tasks (translocation, clip & cut, and tissue dissection, based on the fundamentals of laparoscopic surgery) in the box trainer in laparoscopy and SPA settings with both (conventional) crossed and curved instruments. All participants completed a questionnaire, which asked their opinion on the use of instruments and preference.ResultsTranslocation was performed significantly faster in both laparoscopy and SPA crossed than SPA curved (means, 130.3 and 137.7 vs. 170.7 sec; p < 0.001 and p = 0.005). The errors also were less in laparoscopy and SPA crossed (means, 0.9 and 1.2 vs. 1.6), but not significant. The time to complete the dissection was almost equal between laparoscopy and SPA curved settings, but took longer for SPA crossed, although not significantly (148.1 and 150.8 vs. 179.5 sec). The errors only differed significantly between laparoscopy and SPA crossed (means, 0.5 vs. 1.27; p = 0.044). Fourteen participants still favored conventional laparoscopy and one SPA curved. They also thought SPA curved was better than crossed (means, 3.6 vs. 2.47; p = 0.003) and that exposure is superior in curved (means, 3.4 vs. 2.27; p = 0.002).ConclusionsAlthough conventional laparoscopy may appear most effective for proper dissection and exposure of tissue, single-port access surgery shows potential. Especially in the tissue dissection task, there is no significant difference in time or errors between conventional laparoscopy and SPA surgery, using specially designed curved instruments. Although the participants favor conventional laparoscopy, this could evolve to a more accepting mind when SPA surgery becomes more available and used in the clinical setting.

Comparison of different sets of instruments for laparoendoscopic single‐site surgery in a surgical simulator with novices

“…In the task of peg transferring, participants using two conventional straight instruments perform better than the other three groups in the beginning because of the simplicity of the task and their familiarity with the conventional straight instruments. With the increasing complexity of pattern cutting, the specially designed instruments demonstrate the superiority, gaining a higher score . Participants require more drills to reach the pattern‐cutting plateau with all four sets of instruments, which may indicate LESS itself contributes more to the increased length of the learning curve than the specific instruments.…”

Single incision transumbilical laparoscopic varicocelectomy versus the conventional laparoscopic technique: A randomized clinical study

“…The most important is loss of triangulation between the two instruments due to their parallel entry through the single port which makes dissection more difficult with deceased visualization and exposure [20,21]. Sword-fighting of the laparoscope and instruments around the umbilicus is another added problem.…”

Retroperitoneal Laparoendoscopic Single-Site Adrenalectomy: Our Initial Technical Experience

“…We therefore replaced these instruments with a conventional rigid instrument in the dominant hand and a curved one in the other hand, whereby the curved instrument was used to fix the tissue and the rigid instrument was used for the major handling during surgery, and found that this set-up decreased handling difficulties. Botden et al 16 reported that conventional rigid instruments can also be used to successfully perform the LESS procedure, but we consider that a curved instrument can increase the angle of the instruments and thus provide a better handling view. Moreover, the curved instruments we used were 5 cm longer than the rigid instruments, which meant that the two hands were not at the same level, and this therefore reduced interference between the hands (Fig.…”