title: The need for training frameworks and scientific evidence in developing scarless surgery: a national survey of surgeons' opinions on single port laparoscopic surgery.
abstract: BACKGROUND
  Single port/incision laparoscopic surgery (SPILS) is a recent innovation in minimally invasive surgery whereby operations are performed through a single point of entry. Despite the relative paucity of clinical data, the procedure is increasingly being used to minimise scarring and pain associated with the multiple entry points of traditional laparoscopic surgery. This study aimed to analyse the awareness, experience and opinions of British surgeons regarding SPILS.
  
  
  METHODS
  Electronic, 13-item, self-administered, anonymous questionnaire survey distributed via national/regional surgical mailing lists and websites. Results were collated and analysed with SPSS v17.0 for Windows (SPSS, Inc, Chicago, IL).
  
  
  RESULTS
  342 fully completed responses received, including 72 (21%) Consultants and 189 (55%) higher surgical trainees. Overall 330 (96.5%) were aware of SPILS; there was no significant difference in awareness between grades. Only 37% had assisted or performed SPILS procedures. More consultants performed these than trainees (56.3 vs 32.0%, p < 0.05). Operative experience was limited, with only 6% of those undertaking SPILS performing ≥25 procedures, and 60% performing ≤5. 61.4% believed SPILS takes longer to perform, and 32.8% believed it has higher complication rate. Factors cited as limiting uptake included: lack of evidence (70%), insufficient training opportunities (78%), incorrect instrumentation (70%), increased cost (62%), and hospital policy (44.5%). Patient preference was considered to have negatively affected SPILS uptake by only 9% of respondents. A greater proportion of trainees (94.6% vs 78.9%) felt there were insufficient SPILS training opportunities (p = 0.001).
  
  
  CONCLUSIONS
  Although awareness of SPILS is high, operative experience is limited and negative perceptions regarding operating time and complications remain. The findings suggest future uptake relies strongly on the availability of evidence, training, instrumentation and reduced costs. Scientific studies are still awaited to assess effectiveness and provide clinical and economic evaluation.
authors.affiliation: Edinburgh Royal Infirmary, EH16 5JP, UK. haroon.rehman.06@aberdeen.ac.uk
authors.forename: H
authors.initials: H
authors.lastname: Rehman
authors.forename: J E F
authors.initials: JE
authors.lastname: Fitzgerald
authors.forename: J
authors.initials: J
authors.lastname: Frantzias
authors.forename: J
authors.initials: J
authors.lastname: Lemon
authors.forename: I
authors.initials: I
authors.lastname: Ahmed
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002921:Cicatrix / Q000517:prevention & control; D002983:Clinical Competence; D003625:Data Collection; D004502:Education, Medical, Continuing / Q000458:organization & administration*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education* / Q000379:methods* / Q000592:standards / Q000639:trends; D008297:Male; D010820:Physicians / Q000458:organization & administration* / Q000523:psychology / Q000592:standards; D016032:Randomized Controlled Trials as Topic; D011795:Surveys and Questionnaires; D006113:United Kingdom