Spider surgical system versus multiport laparoscopic surgery: performance comparison on a surgical simulator.
BACKGROUND
The rising interest towards minimally invasive surgery has led to the introduction of laparo-endoscopic single site (LESS) surgery as the natural evolution of conventional multiport laparoscopy. However, this new surgical approach is hampered with peculiar technical difficulties. The SPIDER surgical system has been developed in the attempt to overcome some of these challenges. Our study aimed to compare standard laparoscopy and SPIDER technical performance on a surgical simulator, using standardized tasks from the Fundamentals of Laparoscopic Surgery (FLS).


METHODS
Twenty participants were divided into two groups based on their surgical laparoscopic experience: 10 PGY1 residents were included in the inexperienced group and 10 laparoscopists in the experienced group. Participants performed the FLS pegboard transfers task and pattern cutting task on a laparoscopic box trainer. Objective task scores and subjective questionnaire rating scales were used to compare conventional laparoscopy and SPIDER surgical system.


RESULTS
Both groups performed significantly better in the FLS scores on the standard laparoscopic simulator compared to the SPIDER. Inexperienced group: Task 1 scores (median 252.5 vs. 228.5; p = 0.007); Task 2 scores (median 270.5 vs. 219.0; p = 0.005). Experienced group: Task 1 scores (median 411.5 vs. 309.5; p = 0.005); Task 2 scores (median 418.0 vs. 331.5; p = 0.007). Same aspects were highlighted for the subjective evaluations, except for the inexperienced surgeons who found both devices equivalent in terms of ease of use only in the peg transfer task.


CONCLUSIONS
Even though the SPIDER is an innovative and promising device, our study proved that it is more challenging than conventional laparoscopy in a population with different degrees of surgical experience. We presume that a possible way to overcome such challenges could be the development of tailored training programs through simulation methods. This may represent an effective way to deliver training, achieve mastery and skills and prepare surgeons for their future clinical experience.
Department of Surgical Sciences Policlinico "Umberto I, "Sapienza" University of Rome, Viale Regina Elena, 324, Rome, Italy.
Domenico
D
Giannotti
Department of Surgical Sciences Policlinico "Umberto I, "Sapienza" University of Rome, Viale Regina Elena, 324, Rome, Italy.
Giovanni
G
Casella
Department of Surgical Sciences Policlinico "Umberto I, "Sapienza" University of Rome, Viale Regina Elena, 324, Rome, Italy. g_patrizi@yahoo.com.
Gregorio
G
Patrizi
Department of Surgical Sciences Policlinico "Umberto I, "Sapienza" University of Rome, Viale Regina Elena, 324, Rome, Italy.
Giorgio
G
Di Rocco
Department of Surgical Sciences Policlinico "Umberto I, "Sapienza" University of Rome, Viale Regina Elena, 324, Rome, Italy.
Lidia
L
Castagneto-Gissey
Department of Surgical Sciences Policlinico "Umberto I, "Sapienza" University of Rome, Viale Regina Elena, 324, Rome, Italy.
Alessio
A
Metere
Department of Radiology, Oncology and Pathology, "Sapienza" University of Rome, Rome, Italy.
Maria Giulia
MG
Bernieri
Department of Public Health and Infectious Diseases, "Sapienza" - University of Rome, Rome, Italy.
Anna Rita
AR
Vestri
Department of Surgical Sciences Policlinico "Umberto I, "Sapienza" University of Rome, Viale Regina Elena, 324, Rome, Italy.
Adriano
A
Redler
D000328:Adult; D002983:Clinical Competence; D006801:Humans; D010535:Laparoscopy / Q000193:education / Q000295:instrumentation* / Q000379:methods; D012384:Rome; D000066908:Simulation Training