Single Port Access Surgery: Performance Difficulty and a Possible Solution

Introduction: During single port access surgery (SPA), surgeons often find it difficult to triangulate their instruments to the target organ. Their hand movements are limited by the single port access to the abdominal cavity. The first goal of this study is to quantify the level of difficulty in performing a SPA procedure as compared to a laparoscopic procedure.
Articulating instruments are currently available for SPA procedures. Such instruments enable end-effectors to bend and triangulate to the surgical site. The second goal of this study is to evaluate the benefit of using articulating instruments versus conventional rigid laparoscopic instruments during a SPA procedure.
We hypothesized that surgeons would require more time to perform tasks through a single port access device than with multiple laparoscopic ports. In addition, performance during a SPA procedure would be better with the use of articulating instruments instead of conventional rigid instruments.
Methods: Using a bench-top training box, a peg transfer task was performed by surgeons with various levels of experience. Each surgeon was required to finish the task using either a pair of conventional (rigid) graspers placed through two separate ports, or through a single port. The procedure was repeated using a pair of articulating instruments (Novaris Free-hand graspers). The order of each task was randomly assigned to each surgeon. Task performance was evaluated by movement speed and accuracy.
Results: A total of 17 surgeons were recruited. The SPA tasks required significantly more time to complete than when two ports were used (62% longer). Performance with conventional rigid instruments was significantly worse during SPA than with two ports (173 vs. 108 sec; p < 0.001). Articulating instruments reduced the SPA task performance time by 30% (p = 0.896) but they did not improve the two-port performance time. Experienced laparoscopic surgeons performed better than surgical residents when using conventional instruments (p = 0.045) but there was no significant difference with articulating instruments (p = 0.307).
Conclusion: Tasks performed through a single port require more time to complete than those performed using multiple ports. Articulating instruments that allow triangulation improve SPA performance moderately. However, when multiple ports are used, the use of articulating instruments does not improve performance when compared to conventional rigid laparoscopic instruments.

Session: Poster

Program Number: P279

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