Riggle Jakeb D, Miller Emily E, McCrory Bernadette, Meitl Alex, Lim Eric, Hallbeck M Susan, LaGrange Chad A
University of Nebraska Medical Center , Omaha, NE , USA.
Minim Invasive Ther Allied Technol. 2015 Apr;24(2):68-76. doi: 10.3109/13645706.2014.946426. Epub 2014 Aug 21.
Single-site surgery improves cosmesis but increases procedural difficulty. Enhanced instruments could improve procedural efficiency leading to better patient outcomes.
One pair of non-articulating (straight) and two different pairs of articulating laparoscopic instruments were evaluated using a peg-transfer surgical task simulator by premedical college students. The instruments were comparatively tested using task performance measures, ergonomic measures, and participant questionnaires.
The straight instrument produced significantly higher task performance scores and lower task times compared to both articulating instruments (p < 0.05). The straight instrument required less muscle activation and less wrist deviation than the articulating instruments to perform the same task. Participants rated the straight instrument significantly easier to use and less difficult to complete the task than with either articulating instrument (p < 0.05 for both).
This exploratory study suggests that novices have difficulty using articulating instruments and perform better using straight laparoscopic instruments when first attempting LESS surgical tasks. Although a study with post-graduate medical trainees is needed to confirm these results, trainees should initially practice LESS with non-articulating instruments to gain proficiency at basic laparoscopic tasks. Additionally, redesigning articulating instruments to specifically address the spatial constraints and learning curve of LESS may also improve trainee performance and instrument usability.
单孔手术改善了美观效果，但增加了手术难度。改进的器械可以提高手术效率，从而带来更好的患者预后。
医学院预科学生使用移钉手术任务模拟器对一对非关节式（直的）和两对不同的关节式腹腔镜器械进行了评估。通过任务绩效指标、人体工程学指标和参与者问卷对器械进行了对比测试。
与两种关节式器械相比，直器械产生的任务绩效得分显著更高，任务时间更短（p < 0.05）。在执行相同任务时，直器械比关节式器械需要更少的肌肉激活和更少的手腕偏斜。参与者对直器械的评价是，与两种关节式器械相比，使用起来明显更容易，完成任务的难度更小（两者p < 0.05）。
这项探索性研究表明，新手在首次尝试单孔腹腔镜手术任务时，使用关节式器械存在困难，而使用直的腹腔镜器械表现更好。尽管需要对医学研究生进行研究以证实这些结果，但学员最初应使用非关节式器械练习单孔腹腔镜手术，以熟练掌握基本的腹腔镜手术任务。此外，重新设计关节式器械以专门解决单孔腹腔镜手术的空间限制和学习曲线问题，也可能提高学员的表现和器械的易用性。
