Simulation and Performance of Single Site Surgery

Pamela Burgess, MD, Joel Brockmeyer, MD, Byron Faler, MD, Yong Choi, MD. Dwight D. Eisenhower Army Medical Center


Interest in Laparoendoscopic Single Site (LESS) surgery has been increasing in the past several years. While the benefits of LESS surgery are limited to cosmesis at this time, a recent survey performed at a meeting of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) indicated that a majority of participants anticipated widespread acceptance of LESS surgery as a commonly used modality in the future. Citing improved cosmesis, theoretical reduced pain, and quicker return to work, more surgeons are offering this to patients. Despite definite benefits, LESS has been demonstrated to be safe in small studies.
Laparoscopic simulation has become a necessity in training general surgeons. Studies have shown consistently that the more frequently a surgeon performs a procedure, the better they become. Much study has been done demonstrating that practice in a simulation lab can improve scores of set levels of skill which can be transferred to the operating room.
Fundamental Laparoscopic Skills (FLS) has positioned conventional laparoscopy (LAP) within the general surgery curriculum by requiring graduating residents to be proficient with skills that have been validated as objective measures.
We hypothesize that simulation training with LESS trainers will improve scores on the PEG transfer portion of FLS more than training on a conventional laparoscopic simulation trainers.
Medical students were recruited and randomized to practice with a (LESS) surgery trainer or the standard FLS trainer. (LESS) training was performed with standard straight laparoscopic instruments using the GELPoint system (Applied Medical). Data was collected regarding gender, handedness, video game systems owned and hours played per week, as well as varsity sports played. They were given a brief introduction and allowed to practice for 15 minutes during which each completed >5 repetitions of transfer. They were then tested in the PEG transfer on the (LESS) surgery trainer.
14 students were recruited for participation, 6 females and 8 males. The subjects were randomized into the two groups with seven subjects per group. All subjects were right handed. No difference was identified between groups in regards to age or gender. Mean score between the groups was 141 and 98 in the LAP and LESS groups respectively (p=0.143). On regression analysis, varsity sports played and number of gaming systems owned were not significant. Female gender was found to be an independent predictor of a higher score, correlation coefficient of 58.530 (p=0.045), as well as number of gaming systems owned, 29.359 (p=0.026).
LESS surgery is on the forefront of surgical innovation with new technology constantly in development. While new technologies are intuitive, they have yet to show true utility and their learning curve has been prohibitive. This study, while small in number, demonstrates that after a single session there is no statistical difference between scores regardless of simulation system. An improvement in laparoscopic skills based on video gaming skills has been shown recently and is shown again in this study. The unexpected difference in scores between genders is interesting and requires further investigation.

Session Number: Poster – Poster Presentations
Program Number: P166
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