title: Single incision laparoscopic surgery - is it time for laboratory skills training?
abstract: BACKGROUND
  With the introduction of new surgical equipment, there is always the need for new, more advanced training. The authors try to answer whether the use of the newest generation tools has an impact on achieving better results in single incision laparoscopic surgery (SILS) technique during the exercises in the surgical skills laboratory.
  
  
  METHODS
  There were 51 participants in the study: 44 'novices' and 7 'experts'. All subjects performed the 'advanced grasping' exercise according to the FLS programme manual using four types of laparoscopic approach including two SILS ports and SILS-dedicated instruments. The outcome measures involved task completion time and the number of errors.
  
  
  RESULTS
  Tasks using straight laparoscopic instruments set together with classic three-port access as well as SILS access ports were finished significantly faster when compared with SILS-dedicated instruments (p < 0.05). There were no significant differences in performance times between the two setups with straight instruments (p < 0.05) and both setups with SILS-dedicated instruments, irrespective of the use of curved or dynamic articulated tools. Students with no previous laparoscopic experience had significantly worse task completion times in all tasks in comparison to students with laparoscopic laboratory training and the 'experts' group.
  
  
  CONCLUSIONS
  The use of the straight instruments in the SILS technique remain similar to its performance in full triangulation. SILS-dedicated instruments paradoxically increase the task completion time irrespective of possessed skills. The study showed the necessity of a SILS-dedicated tools training programme.
authors.affiliation: Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Poland.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Laski
authors.forename: Tomasz J
authors.initials: TJ
authors.lastname: Stefaniak
authors.forename: Wojciech
authors.initials: W
authors.lastname: Makarewicz
authors.forename: Maciej
authors.initials: M
authors.lastname: Bobowicz
authors.forename: Jarosław
authors.initials: J
authors.lastname: Kobiela
authors.forename: Behzad
authors.initials: B
authors.lastname: Nateghi
authors.forename: Monika
authors.initials: M
authors.lastname: Proczko
authors.forename: Ilona
authors.initials: I
authors.lastname: Madejewska
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Gruca
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Sledzinski
keywords: articulated tools; curved tools; minimally invasive surgery; single incision laparoscopic surgery; surgery didactics; surgical education