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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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Related in: MedlinePlus

The protocol of the study. The 15 participants were allotted to two groups to avoid bias in the results of the SPA settings
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Fig6: The protocol of the study. The 15 participants were allotted to two groups to avoid bias in the results of the SPA settings

Mentions: The 15 participants were randomly assigned to two groups. Both groups started with the conventional laparoscopy setting because they were all familiar with this surgical approach. Group A began the tasks in the SPA-crossed setting and next in the SPA-curved setting. Group B started the same tasks in the SPA-curved setting, followed by the SPA-crossed setting (Fig. 6). This construction was used to correct for a possible learning curve bias. All 15 participants completed the tasks on all three settings. In the conventional laparoscopy setting, the tasks were performed twice, whereas in the curved and crossed SPA setting, the tasks were performed three times. The second task was performed once in the conventional laparoscopy setting and twice in the crossed SPA setting because of the limited availability of endoclips and high cost of the disposable variant. The first runs of all the tasks in all settings were not considered in our results, to avoid the bias of unfamiliarity with both the task and the setting. In the SPA setting, both the second and third runs were processed to calculate the differences between the techniques and instruments. After the completion of the study, an evaluation form was filled out by the participants.Fig. 6


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)

The protocol of the study. The 15 participants were allotted to two groups to avoid bias in the results of the SPA settings
© Copyright Policy
Related In: Results  -  Collection

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

Fig6: The protocol of the study. The 15 participants were allotted to two groups to avoid bias in the results of the SPA settings
Mentions: The 15 participants were randomly assigned to two groups. Both groups started with the conventional laparoscopy setting because they were all familiar with this surgical approach. Group A began the tasks in the SPA-crossed setting and next in the SPA-curved setting. Group B started the same tasks in the SPA-curved setting, followed by the SPA-crossed setting (Fig. 6). This construction was used to correct for a possible learning curve bias. All 15 participants completed the tasks on all three settings. In the conventional laparoscopy setting, the tasks were performed twice, whereas in the curved and crossed SPA setting, the tasks were performed three times. The second task was performed once in the conventional laparoscopy setting and twice in the crossed SPA setting because of the limited availability of endoclips and high cost of the disposable variant. The first runs of all the tasks in all settings were not considered in our results, to avoid the bias of unfamiliarity with both the task and the setting. In the SPA setting, both the second and third runs were processed to calculate the differences between the techniques and instruments. After the completion of the study, an evaluation form was filled out by the participants.Fig. 6

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