Department of Surgery, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 650, Chicago, IL 60611, USA.
Surg Endosc. 2011 Feb;25(2):483-90. doi: 10.1007/s00464-010-1197-5. Epub 2010 Jun 29.
Single-incision laparoscopic surgery (SILS™) is a potentially less invasive approach than standard laparoscopy (LAP). However, SILS™ may not allow the same level of manual dexterity and technical performance compared to LAP. We compared the performance of standardized tasks from the Fundamentals of Laparoscopic Surgery (FLS) program using either the LAP or the SILS™ technique.
Medical students, surgical residents, and attending physicians were recruited and divided into inexperienced (IE), laparoscopy-experienced (LE), and SILS™-experienced (SE) groups. Each subject performed standardized tasks from FLS, including peg transfer, pattern cutting, placement of ligating loop, and intracorporeal suturing using a standard three-port FLS box-trainer with standard laparoscopic instruments. For SILS™, the subjects used an FLS box-trainer modified to accept a SILS Port™ with two working ports for instruments and one port for a 30° 5-mm laparoscope. SILS™ tasks were performed with instruments capable of unilateral articulation. SILS™ suturing was performed both with and without an articulating EndoStitch™ device. Task scores, including cumulative laparoscopic FLS score (LS) and cumulative SILS™ FLS score (SS), were calculated using standard time and accuracy metrics.
There were 27 participants in the study. SS was inferior to LS in all groups. LS increased with experience level, but was similar between LE and SE groups. SS increased with experience level and was different among all groups. SILS™ suturing using the articulating suturing device was superior to the use of a modified needle driver technique.
SILS™ is more technically challenging than standard laparoscopic surgery. Using currently available SILS™ platforms and instruments, even surgeons with SILS™ experience are unable to match their overall LAP performance. Specialized training curricula should be developed for inexperienced surgeons who wish to perform SILS™.
单切口腹腔镜手术（SILS）相较于标准腹腔镜（LAP）是一种潜在的微创方法。然而，与 LAP 相比，SILS 可能无法达到相同的手动灵巧性和技术性能水平。我们比较了使用 LAP 或 SILS 技术完成腹腔镜外科基本技能（FLS）计划标准化任务的表现。
招募了医学生、外科住院医师和主治医生，并将他们分为无经验（IE）、腹腔镜经验（LE）和 SILS 经验（SE）组。每个受试者均使用标准三端口 FLS 箱式训练器和标准腹腔镜器械完成 FLS 的标准化任务，包括销钉转移、模式切割、结扎环放置和腔内缝合。对于 SILS，受试者使用 FLS 箱式训练器进行改造，以接受 SILS 端口，该端口有两个用于器械的工作端口和一个用于 30°5mm 腹腔镜的端口。SILS 任务使用能够单边铰接的器械完成。SILS 缝合既可以使用也可以不使用铰接的 EndoStitch 装置完成。使用标准的时间和准确性指标计算包括累积腹腔镜 FLS 评分（LS）和累积 SILS FLS 评分（SS）在内的任务评分。
本研究共有 27 名参与者。在所有组中，SS 均劣于 LS。LS 随经验水平增加而增加，但 LE 和 SE 组之间相似。SS 随经验水平增加而增加，且在所有组之间不同。使用铰接缝合装置进行 SILS 缝合优于使用改良的持针器技术。
SILS 比标准腹腔镜手术更具技术挑战性。即使是具有 SILS 经验的外科医生，使用当前可用的 SILS 平台和器械也无法达到其整体 LAP 性能。希望进行 SILS 的无经验外科医生应制定专门的培训课程。
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