Learning curves for single-site laparoscopic ovarian surgery.
ABSTRACT To compare learning curves for laparoendoscopic single-site surgery (LESS) for ovarian tumors according to the type of procedure (oophorectomy vs cystectomy).
A prospective cohort study. (Canadian Task Force Classification II-2).
One hundred fifteen patients who planned to undergo LESS for ovarian tumors by a surgeon between May 2008 and August 2010.
The learning curve was assessed through the graph between the operative time and sequence of cases. Proficiency, defined as the point at which the slope of the learning curve became less steep, and surgical outcome were compared between the two surgery groups. LESS was successfully completed in 103 of 115 patients (94.8%). Learning curve for oophorectomies (n = 59) showed a continued slow slope with no apparent proficiency, suggesting oophorectomies did not pose an initial technical challenge. However, proficiency in cystectomies (n = 56) was evident at the thirty-third case. Furthermore, the oophorectomy group had a shorter operative time and less need for additional ports than the cystectomy group (69.4 minutes vs 100.1 minutes; 5.1% vs 14.3%).
Oophorectomy rather than cystectomy is recommended as the initial procedure to start with LESS for ovarian tumors.
- [show abstract] [hide abstract]
ABSTRACT: BACKGROUND: Laparoendoscopic single-site (LESS) surgery has been established for various procedures. Shortcomings of LESS surgery include loss of triangulation, instrument collisions, and poor ergonomics, making advanced laparoscopic tasks especially challenging. We compared a LESS system with a robotic single-site surgery platform in performance of a suturing and knot-tying task under clinically simulated conditions. METHODS: Each of five volunteer minimally invasive surgeons was tasked with suturing a 5 cm longitudinal enterotomy in porcine small intestine with square knots at either end, using a laparoendoscopic or da Vinci robotic single-site surgery platform, within a 20 min time limit. A saline leak test was then performed. Each surgeon performed the task twice using each system. The time to completion of the task and presence of a leak were noted. Fisher's exact test was used to compare the overall completion rate within the defined time limit, and a Wilcoxon rank test was used to compare the specific times to complete the task. A p value of <0.05 was considered significant. RESULTS: All surgeons were able to complete the task on the first try within 20 min using the robot system; 60 % of surgeons were able to complete it after two attempts using the LESS surgery system. Time to completion using the robot system was significantly shorter than the time using the standard LESS system (p < 0.0001). There were no leaks after closure with the robot system; the leak rate following the standard LESS system was 90 %. CONCLUSIONS: Surgeons demonstrated significantly better suturing and knot-tying capabilities using the robot single-site system compared to a standard LESS system. The robotic system has the potential to expand single-site surgery to more complex tasks.Surgical Endoscopy 02/2013; · 3.43 Impact Factor
- [show abstract] [hide abstract]
ABSTRACT: PURPOSE: Ovarian masses in the pediatric population are commonly resected with a three or four port laparoscopic approach. Single-incision laparoscopic (SIL) resection is an alternative approach. However, there is limited experience with this modality in ovarian mass resection. METHODS: We reviewed SIL ovarian mass resections performed by our group from 2010 to 2012. We evaluated patient demographics, surgery statistics, and hospital course. RESULTS: Six patients were identified with mean age of 14 years. Imaging studies showed cystic masses ranging 4-6 cm in five patients, and 20 cm in one patient. One patient presented with recurrent teratoma. Pathology revealed four benign teratomas, one benign cyst, and one serous cystadenoma. Average operating time was 75 min. All patients had an ovarian-preserving resection. Three patients had cyst spillage, including the one who presented with recurrence (this was the only patient with a subsequent recurrence). Hospital stay averaged 37 h. Narcotic use averaged 9.9 mg of morphine daily. All patients had excellent cosmetic results, and no postoperative complications. CONCLUSIONS: Ovarian cystic mass excision using the SIL approach carries a higher risk of tumor spillage. Although the incidence of malignancy is low, they cannot be conclusively excluded with our current preoperative evaluations. At this time, we recommend SIL resection only for simple cysts with low malignant potential; however, further experience with this procedure will likely improve the risk of tumor spillage in the future.Pediatric Surgery International 06/2013; · 1.22 Impact Factor