Single Port Surgery Requires Unique Skills
A poster presented at the 12th World Congress Of Endoscopic Surgery in April of this year concluded that single port surgery laparoscopic surgery requires unique skills that can—and need to—be learned by surgeons in order to perform the technique effectively.
In the research, titled “Performance Ramifications of Single Port Laparoscopic Surgery: Measuring Differences in Task Performance Using Simulation,” Nathan E Conway, MD and colleagues suggest that single port laparoscopic surgery is a promising technique, but one that may be associated with specific psychomotor challenges such as use of articulated and/or deliberately crossed instruments.
Using surgical simulation, the researchers defined performance differences in surgeons with single port clinical experience, and those without. The researchers concluded that specialized training is, in fact, necessary in order to safely practice single port surgery.
In the study, participants were assigned three groups: residents (RES), experienced laparoscopic surgeons (LAP) and surgeons with prior clinical single port laparoscopic experience (SP). All participants performed the FLS Precision Cutting task with the ProMIS™ computer-enhanced laparoscopic trainer. Roticulating EndoGrasp™ and Roticulating EndoShears™ instruments were used either in straight confituation via conventional laparoscopic ports or in a starting crossed instrument configuration with the grasper maximally articulate, placed via a SILS™ Port.
All the study particpatns viewed the task tutorial before doing the procedure, each method was performed in two iterations and staring method was alternated. The simulator measured:
- Time in seconds
- Path length in millimeters.
- Smoothness in the number of recorded velocity changes.
Accuracy in millimeters away from the target, non-target material area was recorded manually.
The results showed that task time was faster for the SP group for both laparoscopic and single-port methods. Path length, smoothness and accuracy were not significantly different between the groups for either method. The LAP group path length was longer for the single port task than conventional laparoscopy tasks, and the RES group was slower with longer path length and with lower associated smoothness on the single port task than on conventional laparoscopic tasks. Accuracy showed no significant differences.
In the end, researchers concluded that single port laparoscopic surgery requires unique skills that can be learned by surgeons. The research suggests that expert laparoscopic surgeons with clinical experience in single port surgery through training in animal and clinical settings perform single port tasks better. The researchers recommend systematic lab-based single port training prior to clinical application as is now done for conventional laparoscopy.