title: Analysis of standard multiport versus single-site access for laparoscopic skills training.
abstract: BACKGROUND
  Single-site-access (SSA) laparoscopy is more challenging to perform than multiport (MP) laparoscopy. This study examined the effect of MP versus SSA skills training on laparoscopic performance using surgically naive medical students.
  
  
  METHODS
  For the study, 40 medical students at the end of their first year were randomized into two groups. Both groups were trained in four basic laparoscopic drills (peg, rope, bean drop, pattern cutting) using a standard MP setup (group 1) and an SSA approach (group 2). The time and number of repetitions required to attain proficiency were recorded. Each group then crossed over to the alternate approach and repeated the sequence. Data are presented as mean ± standard deviation, and statistical analysis was performed using the two-tailed, unpaired t test.
  
  
  RESULTS
  The total times required to attain proficiency for the SSA and MP approaches were not significantly different between the MP-trained group (234.0 ± 114.9 min) and the SSA-trained group (216.4 ± 106.5 min) (p = 0.67). The MP-trained group required less time to reach proficiency on the standard MP setup than the group using the SSA approach (119.1 ± 69.7 vs. 178.0 ± 93.4 min; p = 0.058) and significantly fewer repetitions (77.6 ± 42.6 vs. 118.8 ± 54.3; p = 0.027). The SSA-trained group required significantly less time to reach proficiency on the MP setup than the standard MP-trained group (38.4 ± 29.4 vs. 119.1 ± 69.7 min; p = 0.0013) and needed only a mean of 26.9 repetitions. When the standard MP trainees crossed over to the SSA setup, they required significantly less time to reach proficiency with the SSA approach than the SSA-trained group (114.8 ± 50.5 vs. 178.0 ± 93.4 min; p = 0.026) but required more repetitions than with the MP approach (86.2 ± 35.2 vs. 77.6 ± 42.6; nonsignificant difference).
  
  
  CONCLUSIONS
  Laparoscopic SSA skills training results in longer times and more repetitions to achieve proficiency than MP training, but the skills acquired transfer well to the MP approach.
authors.affiliation: Department of Surgery and Institute for Minimally Invasive Surgery, Washington University School of Medicine, 660 S Euclid Avenue, Box 8109, St. Louis, MO 63110, USA.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Cox
authors.forename: Wenjing
authors.initials: W
authors.lastname: Zeng
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Frisella
authors.forename: L Michael
authors.initials: LM
authors.lastname: Brunt
mesh_terms: D000328:Adult; D002983:Clinical Competence; D004867:Equipment Design; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education* / Q000379:methods; D059032:Learning Curve; D008297:Male; D009048:Motor Skills; D009146:Music; D013177:Sports; D013664:Teaching Materials; D018910:Video Games; D055815:Young Adult