title: Effect of training and instrument type on performance in single-incision laparoscopy: results of a randomized comparison using a surgical simulator.
abstract: OBJECTIVE
  Single-incision laparoscopy (SIL) is potentially less invasive compared with standard laparoscopic surgery (LAP); however, it may be more technically challenging and have a longer learning curve. A two-phase study was conducted to examine the performance of standardized tasks on a surgical simulator by novices during a distributed training period. Phase 1 examined the effect of LAP-specific or SIL-specific training on skill acquisition for both techniques. Phase 2 compared the effectiveness and learning curves of additional instrument types for SIL (straight [STR] vs. dynamic articulating [D-ART]).
  
  
  METHODS
  Medical students without previous surgical experience were randomized to LAP-specific training or SIL-specific training, using static articulating instruments [S-ART] for SIL. LAP and SIL scores on the peg transfer (PEG) and pattern cutting (CIRCLE) tasks from the Fundamentals of Laparoscopic Surgery (FLS) were measured at baseline and after four training sessions. In phase 2, a new group of subjects were randomized to SIL training using STR or D-ART instruments, with similar baseline and post-training testing. FLS task scores were calculated and compared according to training regimen and instrument type.
  
  
  RESULTS
  Forty-five subjects completed the study. All scores improved significantly during the training period. Improvement in LAP score was similar between LAP-trained and SIL-trained groups. Improvement of SIL score was better for the SIL-trained group. Final scores were better and the learning curve was shorter for LAP versus SIL technique, with no differences in SIL scores according to instrument type.
  
  
  CONCLUSIONS
  LAP technique results in superior task performance with a shorter learning curve compared with SIL technique during a standardized training period. SIL-specific simulator training is better than LAP training alone to improve SIL performance. Neither S-ART nor D-ART instruments for SIL are associated with improved performance or shorter learning curve compared with STR instruments.
authors.affiliation: Department of Surgery, Northwestern University, Feinberg School of Medicine, 676 North Saint Clair Street, Suite 650, Chicago, IL 60611, USA.
authors.forename: Byron F
authors.initials: BF
authors.lastname: Santos
authors.forename: Taylor J
authors.initials: TJ
authors.lastname: Reif
authors.forename: Nathaniel J
authors.initials: NJ
authors.lastname: Soper
authors.forename: Eric S
authors.initials: ES
authors.lastname: Hungness
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003198:Computer Simulation; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004867:Equipment Design; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D059032:Learning Curve; D013647:Task Performance and Analysis; D013663:Teaching / Q000379:methods*; D013664:Teaching Materials