Mechanical evaluation of three access devices for laparoendoscopic single-site surgery.
BACKGROUND
Many access devices have been developed for laparoendoscopic single-site surgery (LESS) during recent years. However, investigations are needed to determine which port is most suitable for this relatively new technique. The aim of this study was to evaluate commonly used ports using mechanical approaches in a training simulator. Any port that required less force and shorter surgery times had superior maneuverability.


METHODS
The following three commercially available access devices were evaluated: Multi-ports, TriPort, and single-incision laparoscopic surgery (SILS) Port. A LESS mechanical evaluation platform was developed to investigate the forces that acted on the instruments in the ports while moving along horizontal and vertical axes. In addition, a strain-force measurement system was used to compare the average load on the ports when performing standard maneuvers. Additionally, the task completion time was recorded when the maneuvers in these ports were completed.


RESULTS
During the horizontal displacement of the instrument, the traction forces of the Multi-ports were lower than those of the SILS Port, which were lower than those of the TriPort. The average traction forces were significantly different in pairwise multiple comparisons (P < 0.05). When the instrument was inserted into the ports, the vertical friction forces of the Multi-ports were the lowest and those of the TriPort were the highest. On extraction of the instrument, the friction forces of the Multi-ports remained the lowest, followed by those of the TriPort and SILS Port. There were statistically significant results among all the devices (P < 0.05). The average load required to perform the task was less for the SILS Port than that for the TriPort (P < 0.05). Similarly, the average load for the Multi-ports was significantly less than that for the TriPort (P < 0.001). The participants who used the Multi-ports had significantly faster task times than those who used the SILS Port or TriPort (P < 0.005).


CONCLUSIONS
Compared with the TriPort and SILS Port, the Multi-ports was associated with the least average load and the shortest task performance times in a training simulator. This study demonstrates that the Multi-ports may offer superior maneuverability for LESS.
Department of General Surgery, East Hospital, Tongji University School of Medicine, Shanghai, China.
Xiao-Feng
XF
Xie
Jiang-Fan
JF
Zhu
Cheng-Li
CL
Song
Dong-Sheng
DS
Zhang
Qian-Lin
QL
Zou
D000005:Abdomen / Q000601:surgery; D004724:Endoscopy / Q000193:education / Q000295:instrumentation*; D004867:Equipment Design; D017276:Friction; D006801:Humans; D020706:Laparoscopes; D019060:Minimally Invasive Surgical Procedures / Q000193:education / Q000295:instrumentation*; D013314:Stress, Mechanical; D013647:Task Performance and Analysis; D014143:Traction; D016474:Weight-Bearing
Laparoendoscopic single-site surgery; Mechanical evaluation; Multi-ports; SILS Port; TriPort