Ellen Morrow, MD, Andrew S Wright, MD, Edgar Figuredo, MD, Brant K Oelschlager, MD
University of Washington
Objectives
We aimed to assess the rate of adoption of single incision laparoscopy among participants in industry-sponsored courses. We also aimed to learn about barriers to the adoption of single incision techniques.
Methods
We conducted 7 courses in single incision surgery from 2009 to 2012, all sponsored by one of two industry partners. Participants were General Surgeons (n=42) and Gynecologists (n=12). All courses were structured and included didactic instruction, observation of live cases, dry lab practice in a simulation center, and wet lab practice in live porcine models.
A multiple-choice survey with 12 items was constructed to assess adoption of single incision laparoscopy in this group. The survey was administered in the fall of 2013, 0-3 years from the time of course participation. Results were tabulated and descriptive statistics performed.
Results
Current contact information could be found for 48 participants, of whom 13 responded to the survey (27%). Prior to the course, 38% of respondents had performed at least one single incision laparoscopic procedure. Following the course, 46% of respondents performed at least one single incision laparoscopic procedure. Cases that have been performed via single incision approach by respondents include appendectomy, cholecystectomy, other foregut/bariatric (excluding sleeve and band), oophorectomy, and colectomy. No respondent has performed more than 20 single incision procedures since taking the course. Only two respondents currently perform single incision laparoscopy.
Perceived barriers to single incision laparoscopy were varied; 46% said that the largest barrier was "lack of perceived benefit to patient." Other selected barriers (in order of frequency) included cost, technical challenges, and increased operative time.
62% of respondents reported that their patients are not aware of single incision laparoscopy at the time of their consultation. 77% do not discuss single incision with the patients, or do so only when asked by the patient. 23% spontaneously discuss single incision with patients.
Of respondents with single incision experience, 0% felt that patient satisfaction was better after single incision laparoscopy, with 100% stating that patient satisfaction was equal between single incision and standard laparoscopy. 33% felt that complications were more common in single incision laparoscopy. Half of all respondents wrote free text responses, all of which were negative. Free text responses included comments about umbilical hernias from single incision laparoscopy, poor ergonomics, lack of traction/counter-traction, and increased cost.
Conclusions
In this group of participants in industry-sponsored single incision laparoscopy courses, adoption of single incision laparoscopy was low. The biggest barrier to use of the single incision laparoscopy was lack of perceived benefit to the patient compared to standard laparoscopy.
Session: Poster Presentation
Program Number: P184
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