title: Training With Curved Laparoscopic Instruments in Single-Port Setting Improves Performance Using Straight Instruments: A Prospective Randomized Simulation Study.
abstract: OBJECTIVE
  Lately single-port surgery is becoming a widespread procedure, but it is more difficult than conventional laparoscopy owing to the lack of triangulation. Although, these operations are also possible with standard laparoscopic instruments, curved instruments are being developed. The aims of the study were to identify the effect of training on a box trainer in single-port setting on the quality of acquired skills, and transferred with the straight and curved instruments for the basic laparoscopic tasks, and highlight the importance of a special laparoscopic training curriculum.
  
  
  METHODS
  A prospective study on a box trainer in single-port setting was conducted using 2 groups. Each group performed 2 tasks on the box trainer in single-port setting. Group-S used conventional straight laparoscopic instruments, and Group-C used curved laparoscopic instruments. Learning curves were obtained by daily measurements recorded in 7-day sessions. On the last day, the 2 groups changed instruments between each other.
  
  
  METHODS
  1st Department of Surgery, Semmelweis University of Medicine from Budapest, Hungary, a university teaching hospital.
  
  
  METHODS
  In all, 20 fifth-year medical students were randomized into 2 groups. None of them had any laparoscopic or endoscopic experience. Participation was voluntary.
  
  
  RESULTS
  Although Group-S performed all tasks significantly faster than Group-C on the first day, the difference proved to be nonsignificant on the last day. All participants achieved significantly shorter task completion time on the last day than on the first day, regardless of the instrument they used. Group-S showed improvement of 63.5%, and Group-C 69.0% improvement by the end of the session. After swapping the instruments, Group-S reached significantly higher task completion time with curved instruments, whereas Group-C showed further progression of 8.9% with straight instruments.
  
  
  CONCLUSIONS
  Training with curved instruments in a single-port setting allows for a better acquisition of skills in a shorter period. For this reason, there is a need for proficiency-based conventional, but also for a single-port, laparoscopic training curriculum in general surgery residency education.
authors: 1st Department of Surgery, Semmelweis University, Budapest, Hungary. Electronic address: lukovich66@gmail.com.
authors: Peter
authors: P
authors: Lukovich
authors: 1st Department of Surgery, Semmelweis University, Budapest, Hungary.
authors: Valery Ben
authors: VB
authors: Sionov
authors: 1st Department of Surgery, Semmelweis University, Budapest, Hungary.
authors: Timea
authors: T
authors: Kakucs
mesh_terms: D000328:Adult; D002983:Clinical Competence; D004501:Education, Medical / Q000379:methods*; D004867:Equipment Design; D006801:Humans; D006814:Hungary; D010535:Laparoscopy / Q000193:education* / Q000295:instrumentation*; D009048:Motor Skills; D011446:Prospective Studies; D000066908:Simulation Training; D013525:Surgical Instruments; D011795:Surveys and Questionnaires
keywords: Interpersonal and Communication Skills; Practice-Based Learning and Improvement; Systems-Based Practice; curved instrument; learning curve; single-port training curriculum; straight instrument