title: A randomised comparative study evaluating learning curves of novices in a basic single-incision laparoscopic surgery task.
abstract: OBJECTIVE
  There is currently no objective quantification of the temporal changes in performance associated with a novice surgeon learning single-incision laparoscopic surgery (SILS) operative tasks. Analysing learning curves allows us to objectively quantify performance. The aim was to evaluate if the rate of learning and ultimate proficiency level reached in SILS when using straight or articulating instruments is different to conventional laparoscopy and if training in laparoscopy influences learning or proficiency for SILS.
  
  
  METHODS
  Thirty-six surgically naive medical students were randomised to complete the validated peg transfer task over 50 repetitions using a conventional laparoscopic set-up, SILS set-up with straight instruments or articulated instruments or SILS set-up after having reached proficiency using a conventional laparoscopy.
  
  
  RESULTS
  There was a significant increased overall proficiency between the group trained in conventional laparoscopy and all other groups (p < 0.01), with no difference between the other groups. There was no difference in the rate of learning between the groups. There was no difference in the ultimate proficiency level (p = 0.671) or rate of learning (p = 0.63) when using straight or articulating instruments. There was no difference in ultimate proficiency level (p = 0.59) or learning rate (p = 0.219) seen in the SILS group that had prior training on the task with a conventional laparoscopic set-up.
  
  
  CONCLUSIONS
  The results of this study indicate that the proficiency reached using a conventional laparoscopic set-up cannot be matched using a SILS configuration for the novice surgeon and that the choice of straight or articulated instruments as well as previous laparoscopic training does not confer an advantage in this basic task.
authors.affiliation: Academic Surgical Unit, Department of Surgery, Division of Surgery and Cancer, Imperial College London, 10th Floor QEQM, St. Mary's Hospital, South Wharf Rd, Paddington, London, UK, W2 1NY. m.sodergren@imperial.ac.uk
authors.forename: Mikael
authors.initials: M
authors.lastname: Sodergren
authors.forename: Colleen
authors.initials: C
authors.lastname: McGregor
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Farne
authors.forename: Jiguo
authors.initials: J
authors.lastname: Cao
authors.forename: Zhijun
authors.initials: Z
authors.lastname: Lv
authors.forename: Sanjay
authors.initials: S
authors.lastname: Purkayastha
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
authors.forename: Paraskevas
authors.initials: P
authors.lastname: Paraskeva
mesh_terms: D002983:Clinical Competence; D004501:Education, Medical; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education / Q000295:instrumentation / Q000379:methods*; D059032:Learning Curve; D016014:Linear Models; D008297:Male; D009048:Motor Skills