title: Single-Incision Transumbilical Surgery (SITUS) versus Single-Port Laparoscopic Surgery and conventional laparoscopic surgery: a prospective randomized comparative study of performance with novices in a dry laboratory.
abstract: OBJECTIVE
  To evaluate the Single-Incision Transumbilical Surgery (SITUS) technique as compared to an established laparoendoscopic single-site surgery (LESS) technique (Single-Port Laparoscopic Surgery, SPLS) and conventional laparoscopy (CLS) in a surgical simulator model.
  
  
  METHODS
  Sixty-three medical students without previous laparoscopic experience were randomly assigned to one of the three groups (SITUS, SPLS and CLS). Subjects were asked to perform five standardized tasks of increasing difficulty adopted from the Fundamentals of Laparoscopic Surgery curriculum. Statistical evaluation included task completion times and accuracy.
  
  
  RESULTS
  Overall performances of all tasks (except precision cutting) were significantly faster and of higher accuracy in the CLS and SITUS groups than in the SPLS group (p = 0.004 to p < 0.001). CLS and SITUS groups alone showed no significant difference in performance times and accuracy measurements for all tasks (p = 0.048 to p = 0.989).
  
  
  CONCLUSIONS
  SITUS proved to be a simple, but highly effective technique to overcome restrictions of SPLS. In a surgical simulator model, novices were able to achieve task performances comparable to CLS and did significantly better than using a port-assisted LESS technique such as SPLS. The demonstrated advantages of SITUS may be attributed to a preservation of the basic principles of conventional laparoscopy, such as the use of straight instruments and an adequate degree of triangulation.
authors.affiliation: Department of Urology, University Medical Centre Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Schoenthaler
authors.forename: Tuba
authors.initials: T
authors.lastname: Avcil
authors.forename: Sabina
authors.initials: S
authors.lastname: Sevcenco
authors.forename: Udo
authors.initials: U
authors.lastname: Nagele
authors.forename: Thomas E W
authors.initials: TE
authors.lastname: Hermann
authors.forename: Franklin E
authors.initials: FE
authors.lastname: Kuehhas
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Alexander
authors.initials: A
authors.lastname: Frankenschmidt
authors.forename: Ulrich
authors.initials: U
authors.lastname: Wetterauer
authors.forename: Arkadiusz
authors.initials: A
authors.lastname: Miernik
mesh_terms: D002983:Clinical Competence; D006801:Humans; D010535:Laparoscopy / Q000193:education* / Q000379:methods*; D008953:Models, Anatomic; D009048:Motor Skills; D011446:Prospective Studies; D000066908:Simulation Training; D013647:Task Performance and Analysis; D014472:Umbilicus