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

• Published in: Surgical innovation 2014-02, Vol.21 (1), p.106-111
• Main Authors: Conway, Nathan E., Romanelli, John R., Bush, Ron W., Seymour, Neal E.
• Format: Article
• Language: English
• Subjects: Clinical Competence; Computer Simulation; Education, Medical, Graduate - methods; Humans; Internship and Residency; Laparoscopy - education; Laparoscopy - methods; Psychomotor Performance; Task Performance and Analysis
• ISSN: 1553-3506; 1553-3514
• DOI: 10.1177/1553350613499451

Introduction. Single-port laparoscopic surgery imposes unique psychomotor challenges. We used surgical simulation to define performance differences between surgeons with and without single-port clinical experience and examined whether a short course of training resulted in improved performance. Methods. Study participants were assigned to 3 groups: resident group (RES), experienced laparoscopic surgeons with (SP) and without (LAP) prior single-port laparoscopic experience. Participants performed the Fundamentals of Laparoscopic Surgery precision cutting task on a ProMIS trainer through conventional ports or with articulating instruments via a SILS Port (Covidien, Inc). Two iterations of each method were performed. Then, 6 residents performed 10 successive single-port iterations to assess the effect of practice on task performance. Results. The SP group had faster task times for both laparoscopic (P = .0486) and single-port (P = .0238) methods. The LAP group had longer path lengths for the single-port task than for the laparoscopic task (P = .03). The RES group was slower (P = .0019), with longer path length (P = .0010) but with greater smoothness (P = .0186) on the single-port task than the conventional laparoscopic task. Resident performance task time (P = .005) and smoothness (P = .045) improved with successive iterations. Discussion. Our data show that surgeons with clinical single-port surgery experience perform a simulated single-port surgical task better than inexperienced single-port surgeons. Furthermore, this performance is comparable to that achieved with conventional laparoscopic techniques. Performance of residents declined dramatically when confronted with the challenges of the single-port task but improved with practice. These results suggest a role for lab-based single-port training.