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

Botden S, Strijkers R, Fransen S, Stassen L, Bouvy N - Surg Endosc (2011)

Bottom Line: 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).

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Maastricht University Medical Centre, P. Debyeplein 25, Postal box 5800, 6202 AZ, Maastricht, The Netherlands. Sanne_Botden@hotmail.com

ABSTRACT

Background: Single-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.

Methods: Fifteen 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.

Results: Translocation 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).

Conclusions: Although 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.

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Task 2, clip and cut of strings on the marked locations. In this image, the conventional (straight) instruments are used
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Fig4: Task 2, clip and cut of strings on the marked locations. In this image, the conventional (straight) instruments are used

Mentions: The participants had to place three hemostatic clips on a straw at premarked positions 3-cm apart; following they had to cut on a mark halfway between the clips (Fig. 4). The scores were determined by time of completion (with a cutoff time of 120 s) and penalties. The penalty scores were calculated by measuring the deviation of the clip or cut from the predrawn lines and failure to place the clips properly on the tube. This task could not be performed in the SPA-curved setting, because there was no curved endoclip system available.Fig. 4


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

Botden S, Strijkers R, Fransen S, Stassen L, Bouvy N - Surg Endosc (2011)

Task 2, clip and cut of strings on the marked locations. In this image, the conventional (straight) instruments are used
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3142334&req=5

Fig4: Task 2, clip and cut of strings on the marked locations. In this image, the conventional (straight) instruments are used
Mentions: The participants had to place three hemostatic clips on a straw at premarked positions 3-cm apart; following they had to cut on a mark halfway between the clips (Fig. 4). The scores were determined by time of completion (with a cutoff time of 120 s) and penalties. The penalty scores were calculated by measuring the deviation of the clip or cut from the predrawn lines and failure to place the clips properly on the tube. This task could not be performed in the SPA-curved setting, because there was no curved endoclip system available.Fig. 4

Bottom Line: 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).

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Maastricht University Medical Centre, P. Debyeplein 25, Postal box 5800, 6202 AZ, Maastricht, The Netherlands. Sanne_Botden@hotmail.com

ABSTRACT

Background: Single-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.

Methods: Fifteen 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.

Results: Translocation 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).

Conclusions: Although 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.

Show MeSH
Related in: MedlinePlus