Department of Surgery and Institute for Minimally Invasive Surgery, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8109, St. Louis, MO 63110, USA.
Surg Endosc. 2012 Mar;26(3):714-21. doi: 10.1007/s00464-011-1941-5. Epub 2011 Oct 13.
This study compared the performance of validated laparoscopic tasks on four commercially available single-site-access (SSA) devices with the performance of those tasks on an independent-port (IP) SSA setup.
A prospective, randomized comparison of laparoscopic skills performance on four access devices (ADs) (GelPOINT, SILS Port, SSL Access System, TriPort) and one IP-SSA setup was conducted. A laparoscopic trainer box was used to train 18 (2nd- to 4th-year) medical students, four surgical residents, and five attending surgeons to proficiency in multiport laparoscopy using four laparoscopic drills (i.e., peg transfer, bean drop, pattern cutting, extracorporeal suturing). Drills then were performed in random order on each IP-SSA and AD-SSA setup using straight laparoscopic instruments. Repetitions were timed and errors recorded. Data are presented as mean ± standard deviation. Statistical analysis was performed by two-way analysis of variance (ANOVA) with Tukey HSD post hoc tests.
The attending surgeons had significantly faster total task times than the residents or students (P < 0.001), but the difference between the residents and students was not significant. Pair-wise comparisons showed significantly faster total task times for the IP-SSA setup than for all four AD-SSAs within the student group only (P < 0.05). The total task times for the residents and attending surgeons showed a similar profile, but the differences were not significant. When the data for the three groups were combined, the total task time was less for the IP-SSA setup than for each of the four AD-SSA setups (P < 0.001). Similarly, the IP-SSA setup was significantly faster than three of the four AD-SSA setups for peg transfer, three of the four setups for pattern cutting, and two of the four setups for suturing. No significant differences in error rates between the IP-SSA and AD-SSA setups were detected.
Compared with an IP-SSA laparoscopic setup, AD-SSAs are associated with longer task performance times in a trainer box model, independently of the level of training. Task performance was similar across the different SSA devices.
本研究比较了四种市售单端口附件（SSA）设备和一种独立端口（IP）SSA 设置上验证后的腹腔镜手术任务表现。
前瞻性随机比较了四种通道附件（AD）（GelPOINT、SILS 端口、SSL 接入系统、TriPort）和一个 IP-SSA 设置上的腹腔镜技能表现。腹腔镜训练箱用于培训 18 名（第 2 至 4 年）医学生、4 名外科住院医师和 5 名主治外科医生，使其熟练掌握四端口腹腔镜手术，使用四种腹腔镜训练钻（即，钉转移、豆滴、模式切割、体外缝合）。然后，使用直式腹腔镜器械以随机顺序在每个 IP-SSA 和 AD-SSA 设置上进行训练钻操作。记录重复次数和错误。数据表示为平均值±标准偏差。统计分析采用双因素方差分析（ANOVA）和 Tukey HSD 事后检验。
主治外科医生的总任务时间明显快于住院医师或学生（P < 0.001），但住院医师和学生之间的差异不显著。仅在学生组中，与所有四种 AD-SSA 相比，IP-SSA 设置的总任务时间明显更快（P < 0.05）。住院医师和主治外科医生的总任务时间表现出相似的模式，但差异不显著。当将三组数据合并时，与四种 AD-SSA 中的每一种相比，IP-SSA 设置的总任务时间都更短（P < 0.001）。同样，与 GelPOINT、SILS 端口和 TriPort 相比，IP-SSA 设置在钉转移、模式切割和缝合三个方面的速度都明显更快。在 IP-SSA 和 AD-SSA 设置之间未检测到错误率的显著差异。
与 IP-SSA 腹腔镜设置相比，在训练箱模型中，AD-SSA 与更长的任务执行时间相关，而与训练水平无关。不同 SSA 设备之间的任务表现相似。
