Comparison of different sets of instruments for laparoendoscopic single-site surgery in a surgical simulator with novices.
BACKGROUND
Given the parallel entry of working instruments through a single incision in laparoendoscopic single-site surgery, loss of triangulation in the abdominal cavity and counteracting movements of the instruments are inevitable obstacles. Some specially designed devices have emerged to ameliorate these challenges.


METHODS
Twenty-four novice participants were randomized into four groups using assigned instruments, conventional straight instruments, single-curved instruments, double-curved instruments and articulating instruments, respectively, to perform two basic tasks (peg transferring and pattern cutting) 14 times in a modified simulator. A test of the tasks and a resection of the intestine segment of a rat were performed. The task scores and evaluation of intraoperative skills during the resection of the intestine segment were recorded. The instrument of modified National Aeronautics and Space Administration Task Load Index (NASA-TLX) was completed.


RESULTS
The task scores of the groups using single-curved instruments and articulating instruments were better than the other two groups on the simulator tasks, consistent with the evaluation of intraoperative skills during the resection of intestine segment. As the proficiency with the instruments increased, the task scores improved, as demonstrated by the learning curve. The workload measured by the modified NASA-TLX tool demonstrated that the groups using articulating instruments and double-curved instruments had a heavier workload in most of the categories compared with the other two groups.


CONCLUSIONS
Single-curved and articulating instruments are more effective than conventional straight and double-curved devices, and are favourable in laparoendoscopic single-site surgery for novice learners.
Institute for Minimally Invasive Surgery, Southeast University Medical School, Nanjing, Jiangsu, China.
Dong
D
Wang
Institute for Minimally Invasive Surgery, Southeast University Medical School, Nanjing, Jiangsu, China.
Long-Qing
LQ
Shi
Institute for Minimally Invasive Surgery, Southeast University Medical School, Nanjing, Jiangsu, China.
Jing-Min
JM
Wang
Department of General Surgery, Zhongda Hospital, Institute for Minimally Invasive Surgery, Southeast University Medical School, Nanjing, Jiangsu, China.
Xiao-Hua
XH
Jiang
Department of General Surgery, Zhongda Hospital, Institute for Minimally Invasive Surgery, Southeast University Medical School, Nanjing, Jiangsu, China.
Zhen-Ling
ZL
Ji
D000818:Animals; D002983:Clinical Competence; D004867:Equipment Design; D006801:Humans; D007422:Intestines / Q000601:surgery*; D010535:Laparoscopy / Q000193:education / Q000295:instrumentation*; D051381:Rats; D000066908:Simulation Training / Q000379:methods*; D013647:Task Performance and Analysis; D016526:Workload
LESS; laparoendoscopic single-site surgery; pre-bent instrument; surgical simulator