title: Comparison of single access devices during cut and suturing tasks on simulator.
abstract: BACKGROUND
  Published comparisons of the different available laparoendoscopic single-site surgery (LESS) devices focused on its economic cost and technical aspects. With this study, we aimed to objectively compare the use of three different LESS access devices in controlled experimental tasks.
  
  
  METHODS
  Twenty subjects participated in simulator trials. A cut and an intracorporeal suturing task were carried out. Three single access devices (SILS: SILS(TM) Port, GPN. GelPOINT Advanced Access Platform, and XCN: XCONE) were used according to a randomized nine-session schedule. Completion time was registered and performance objectively assessed with task-specific rating scales. Two blinded expert raters worked over video recordings of the hands-on sessions.
  
  
  RESULTS
  Participants showed improvement with all devices on total cut completion times and significantly for SILS (P = 0.017). The GPN decreased its adapted Global Rating Scale score (P = 0.002) from the first (W1) to the last week (W9). On the suture task, XCN constituted the device with longer completion times compared with SILS (P < 0.001) and to GPN (P < 0.001). There was significant improvement in times from W1 to W9 with XCN (P < 0.001), SILS (P = 0.003), and GPN (P < 0.001). On average summative score, we observed significant improvement in performance with all devices from W1 to W9 (SILS: P = 0.003; GPN: P = 0.001; and XCN: P < 0.001).
  
  
  CONCLUSIONS
  Although we advise surgeons to focus on the specific procedures and patient characteristics to select the most adequate access device to maintain procedural safety standards, single-use devices appear to confer an easier adaptation to LESS surgery.
authors.affiliation: Laparoscopy Unit, Minimally Invasive Surgery Centre Jesús Usón, Cáceres, Spain. Electronic address: amazevedo@ccmijesususon.com.
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Matos-Azevedo
authors.affiliation: Laparoscopy Unit, Minimally Invasive Surgery Centre Jesús Usón, Cáceres, Spain.
authors.forename: Idoia
authors.initials: I
authors.lastname: Díaz-Guëmes Martín-Portugués
authors.affiliation: Laparoscopy Unit, Minimally Invasive Surgery Centre Jesús Usón, Cáceres, Spain.
authors.forename: Francisco Julián
authors.initials: FJ
authors.lastname: Pérez-Duarte
authors.affiliation: Laparoscopy Unit, Minimally Invasive Surgery Centre Jesús Usón, Cáceres, Spain.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Sánchez-Hurtado
authors.affiliation: Scientific Direction, Minimally Invasive Surgery Centre Jesús Usón, Cáceres, Spain.
authors.forename: Francisco Miguel
authors.initials: FM
authors.lastname: Sánchez-Margallo
mesh_terms: D003162:Competency-Based Education / Q000379:methods*; D003198:Computer Simulation; D003194:Computer-Assisted Instruction / Q000295:instrumentation / Q000379:methods*; D004503:Education, Medical, Graduate / Q000379:methods; D004724:Endoscopy / Q000193:education*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D008297:Male; D013536:Suture Techniques / Q000193:education*; D013996:Time and Motion Studies; D014741:Video Recording
keywords: Access devices; Cut tasks; Intracorporeal suturing tasks; LESS surgery; Objective assessment; Physical simulation