Does Previous Laparoscopic Experience Improve the Ability to Perform Single Incision Laparoscopic Surgery?

Trystan M Lewis, Mr, Rajesh Aggarwal, Mr, Richard M Kwasnicki, Mr, Ara Darzi, Prof, Paraskevas Paraskeva, Mr. Imperial College London

Introduction
Single Incision Laparoscopic Surgery (SILS) has been suggested as a safer and less invasive alternative to standard laparoscopic surgery (LAP). It is not clear whether previous laparoscopic experience influences the ability to perform SILS. This study aims to assess the impact of laparoscopic experience on performing SILS.

Methods and Procedures
18 surgeons were recruited, 12 novice surgeons, 4 experienced laparoscopic surgeons (intermediate) and two experienced SILS surgeons (expert). All subjects completed four tasks from the validated Fundamentals of Laparoscopic Surgery (FLS) curriculum. The tasks were performed using both a LAP and SILS approach with a randomized crossover design. Assessment of the tasks was performed using standardized FLS metrics and dexterity analysis using the Imperial College Surgical Assessment Device (ICSAD).

Results
The novice group performed two tasks (precision cutting and intra-corporeal suture) significantly better using a LAP approach than a SILS approach in all parameters (p<0.05). The two other tasks (peg transfer and endoloop) were performed significantly better LAP than SILS for time and dexterity only (p<0.05), but not for error score. The intermediate and expert groups demonstrated no significant difference between their LAP and SILS performance for all tasks in any parameter.
Inter group analysis of performance demonstrated construct validity of the SILS tasks with significant differences between novice and intermediate performance on three tasks (peg transfer, endoloop and intra-corporeal suture) (p<0.05) and between novice and expert performance on three tasks (peg transfer, precision cutting and intra-corporeal suture) (p<0.05).

Discussion
This study demonstrates that previous laparoscopic experience improves your ability to perform SILS tasks. Some SILS tasks do not show construct validity due to the complexity of the SILS technique. It is also implied that current LAP technical skills training curricula are insufficient for teaching SILS.