• Skip to primary navigation
  • Skip to main content
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • SAGES Store
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
    • “Unofficial” Logo Products
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2024 Scientific Session Call For Abstracts
      • 2024 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • Wellness Resources – You Are Not Alone
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Fellows Career Development Course
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES Top 21 MIS Procedures
    • SAGES Pearls
    • SAGES Flexible Endoscopy 101
    • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • OWLS
  • Log In

A Randomised Controlled Trial to Evaluate the Impact of Instrument and Laparoscope Length on Performance and Learning Curve in Single Incision Laparoscopic Surgery

Sathyan Balaji, BSc, Pritam Singh, MBBS, MA, MRCS, Mikael H Sodergren, MBBS, MRCS, PhD, Harry Corker, BSc, Richard M Kwasnicki, BSc, Ara Darzi, MBBS, MD, KBE, FMedSci, FRCS, FACS, Paraskevas Paraskeva, MBBS, PhD, FRCS

Imperial College London, London, United Kingdom

Introduction:
This randomised controlled trial evaluated the effect of varying instrument length on simulated Single Incision Laparoscopic Surgery (SILS) performance. SILS further reduces the invasiveness of laparoscopic surgery. The potential benefits include enhanced cosmesis and reduced pain. However, instrumentation entering adjacent to each other creates difficulties by reducing triangulation and potentially increasing both internal and external collisions. An innovative method of overcoming some of these challenges is to vary instrumentation length.

Method:
Surgeons were eligible if they had performed a minimum of 5 laparoscopic procedures as primary surgeon. Participants completed baseline testing involving one repetition of both the peg transfer (PEG) and pattern cutting (CUT) tasks from the validated Fundamentals of Laparoscopic Surgery (FLS) curriculum using a conventional laparoscopic setup. Subjects were stratified based on surgical experience and randomised into one of 3 trial arms: The control group used standard length instruments (31cm) and a standard length laparoscope (30cm), Group 1 used 1 longer bariatric length instrument (42cm) and 1 standard length instrument and a standard length laparoscope and Group 2 used standard length instruments and a longer bariatric length laparoscope (42cm). The trial was undertaken in two phases using a validated SILS modified FLS box trainer. Phase one involved 25 repetitions of PEG. Phase two involved 5 repetitions of CUT. FLS scoring parameters and the validated hand tracking Imperial College Surgical Assessment Device (ICSAD) measured performance. NASA TLX workload assessment was issued at trial completion. Learning curves were generated using non-linear regression allowing calculation of the learning plateau (surgeons theoretical maximum performance) and learning rate (number of repetitions to reach 90% of maximum score). A non-parametric approach was used for statistical analysis.

Results:
Twenty-three surgeons were recruited to Control (n=7), Group 1 (n=9) and Group 2 (n=7). There were no significant differences in operative experience or baseline FLS scores of PEG and CUT. Phase 1: Peak FLS score was significantly higher in Group 1 compared to control (p<0.05). Learning curves demonstrated no difference in learning rate; however, Group 1 had a significantly higher learning plateau than control (p<0.05). Fifteen surgeons completed CUT in phase 2: Control (n=5), Group 1 (n=6) and Group 2 (n=4). Group 1 revealed a trend towards higher peak FLS scores over control group (p =0.067). NASA TLX workload assessment showed participants in Group 2 (P<0.05) subjectively perceived higher performance than control. ICSAD revealed no significant differences in total path length or number of hand movements between groups in both phases.

Conclusions:
This study demonstrates that varying instrument length can improve performance in a simulated SILS model. The combination of 1 bariatric length and 1 standard length instrument conferred highest performance. This could be a feasible and simple solution to optimise SILS ergonomics with equipment readily available in many minimally invasive surgical units.


Session: Podium Presentation

Program Number: S078

46

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064
1-310-437-0544
[email protected]
Monday - Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2024 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons