Centro Universitario di Chirurgia Mini-Invasiva, Molinette Hospital, University of Turin, Turin, Italy.
Surg Endosc. 2012 Dec;26(12):3605-11. doi: 10.1007/s00464-012-2379-0. Epub 2012 Jun 8.
Despite advancing technology for single-incision minimal access surgery, there have been no reports on the optimal operating setup and the instruments for use through a single port. This study therefore aimed to compare task performance in single-port surgery between crossed and uncrossed instruments (straight and distally coaxially curved).
A dedicated trainer box was used to investigate the performance of two tasks (pick-transfer-place and dissection) by 18 surgical residents using two randomly allocated manipulating systems: (1) a conventional, uncrossed manipulation system (UCMS), with surgery through a cone-shaped 40-mm port using coaxially curved or straight instruments subtending a 30° manipulation angle, and (2) a crossed manipulation system (CMS), with surgery through a cylindrical miniport (25 mm) using coaxially curved instruments.
The pick-transfer-place task performed with the UCMS enabled comparison between straight and curved coaxial instruments and showed that although the participants moved the same number of objects with either type (p = 0.464), they dropped a significantly more objects with straight instruments (1.5 ± 1.33 vs. 0.61 ± 0.85; p = 0.013). The execution of this task with the CMS (curved instruments only) provided a performance (dropped objects and error rates) equal to that obtained by the UCMS with curved instruments (p = 0.521, p = 0.989). The dissection task with the UCMS showed no difference between straight and curved coaxial instruments in dissection accuracy (75.6 vs. 75.5%; p = 0.950) or execution times (258 vs. 302 s; p = 0.367). The performance of this task by the CMS and the UCMS (with curved coaxial instruments) was equivalent with regard to dissection accuracy (p = 0.849) and execution time (p = 0.402).
Using the UCMS, task performance is better with distally curved coaxial instruments. The CMS (with curved instruments) gives a task performance equivalent to that obtained with UCMS.
尽管单切口微创技术不断发展，但目前尚无关于使用单端口的最佳手术设置和器械的报道。因此，本研究旨在比较单端口手术中交叉和非交叉器械（直型和远侧同轴弯曲型）的手术操作性能。
使用专用训练箱，通过两种随机分配的操作系统，由 18 名外科住院医师对两种任务（拾取-转移-放置和解剖）的操作性能进行研究：（1）传统的非交叉操作系统（UCMS），通过使用同轴弯曲或直型器械在圆锥形 40mm 端口下进行手术，手术操作角度为 30°；（2）交叉操作系统（CMS），通过使用圆柱形迷你端口（25mm）和同轴弯曲器械进行手术。
UCMS 下的拾取-转移-放置任务可比较直型和弯曲型同轴器械，结果表明，尽管两种器械的移动物体数量相同（p=0.464），但直型器械的掉落物体明显更多（1.5±1.33 与 0.61±0.85；p=0.013）。CMS（仅使用弯曲器械）下执行该任务的操作性能（掉落物体和错误率）与 UCMS 下使用弯曲器械的操作性能相当（p=0.521，p=0.989）。UCMS 下的解剖任务中，直型和弯曲型同轴器械在解剖准确性（75.6%与 75.5%；p=0.950）或手术时间（258 与 302s；p=0.367）方面均无差异。CMS 和 UCMS（使用弯曲型同轴器械）下执行该任务的性能在解剖准确性（p=0.849）和手术时间（p=0.402）方面相当。
使用 UCMS 时，远侧弯曲型同轴器械的操作性能更好。CMS（使用弯曲器械）可提供与 UCMS 相当的操作性能。
