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57th Annual Meeting Abstracts


Presentation #5

Abstract Title

Performance Ramifications of Single Port Laparoscopic Surgery: Measuring Differences in Task Performance Using Simulation

 

Author Block

Nathan E. Conway MD, John R. Romanelli MD, Ron W. Bush BS, Neal E. Seymour MD 

Baystate Medical Center, Springfield, MA

Abstract Body

INTRODUCTION:  Single port laparoscopic surgery (SPLS) is associated with unique psychomotor challenges. Using single port surgical simulation, we studied performance differences between surgeons with and without single port clinical experience in order to define potential training needs.

METHODS:  Subjects:  Residents (RES; PGY 2-3; n=11), experienced laparoscopic surgeons (LAP; > 100 advanced cases; n=6), and SPLS-experienced surgeons (SP; 2-25 cases; n=4).  Subjects performed the FLS Precision Cutting task on the ProMIS™ laparoscopic trainer (Haptica Ltd., Dublin, Ireland) with A) articulating instruments in straight configuration via conventional laparoscopic ports, and B) with one in maximally-articulated configuration via a SILS™ Port (Covidien, Inc).  Measurements included time (sec), path length (cm), smoothness, and accuracy.  Comparisons between groups were by ANOVA and between methods by Wilcoxon rank sum test.

RESULTS:  Task time was faster for the SP group for both methods (Laparoscopic: SP 151 ± 76, LAP 260 ± 89, RES 222 ± 99, p=0.0486.  Single Port: SP 209 ± 57, LAP 345 ± 113, RES 394 ± 192, p=0.0238).  The RES group was slower (394 ± 186 vs 222 ± 99, p=0.0019), and had longer path length (5451 ± 2704 vs 1622 ± 1164; p=0.0010) on the single port task than on the conventional task.

DISCUSSION:  SPLS requires unique skills that can be learned. Our data show that SPLS-experienced surgeons outperformed those without this experience. Resident performance declined dramatically when challenged with the single port task. These results strongly suggest a role for systematic lab-based single port training before clinical application.

 

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