Table 2 - uploaded by Bijendra P Patel
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Aims: In the rapidly advancing world of laparoendoscopic surgery, surgeons are faced with new devices all of which are aimed towards a single access. Various single-access devices are available on the market. Our study aimed to compare the performance of experienced laparoscopic surgeons on validated laparoscopic tasks using five devices within a s...
Contexts in source publication
Context 1
... performance times for each of the simulation tasks are shown in Table 2. These results were not significantly dif- ferent between the different single-access devices (ANOVA test: peg transfer, P = 0.306; cut pattern, P = 0.819). ...
Context 2
... order to assess performance precision, we looked at the number of errors performed and instrument clashes. The number of errors performed for peg transfer and pattern cut are presented in Table 2. One-way ANOVA showed no significant difference between devices with regard to the mean number of errors for peg transfer (P = 0.182) or pat- tern cut (P = 0.478). ...
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Citations
... have experimented with a variety of methods, of which front-bending instruments and the "cross technique" are widely used [8,9]. Norihiko Ishikawa [10] specifically introduced the application of the "cross technique" for the first time in 2009; since then, the method has been mainstream. ...
... The main bottleneck problem of LESS is the tubular visual field and the collision of the instruments. Previous research has mostly focused on the improvement of instruments [8] to refine LESS, but there are few studies on the improvement of the surgical technique. The present study starts from other perspectives regarding the improvement of surgical techniques to optimize LESS using conventional laparoscopic instruments and equipment, which adjust the position of the surgeon, the layout of the instruments, and the operation technique. ...
Background
The traditional cross technique can be used to complete most laparoendoscopic single-site surgery (LESS) procedures, but some relatively precise operations, such as vaginal stump suturing, are challenging. In practice, we have introduced a novel technique named the chopstick technique and applied it to more complex operations, such as cervical cancer operations, and found that it contributes to performing delicate surgery. The efficacy and safety of two different surgical techniques in LESS hysterectomy remain to be validated.
Methods
Patients who undergo total hysterectomy will be enrolled in this RCT. Stratified randomization will be performed according to uterine size (< 10 cm, 10–15cm, ≥ 15 cm). The participants will be divided into the chopstick technique group or cross technique group to undergo laparoendoscopic single-site total hysterectomy (LESS-TH), and then the perioperative and postoperative data, including the total operation time and other times, transfer rates, estimated blood loss, surgeon fatigue, intraoperative and postoperative complications (within 8 weeks after surgery), health-related quality of life (EQ-5D) scores, postoperative hospital stay, and hospitalization expenses, will be evaluated. The primary outcome is the operating time for total hysterectomy under LESS, and the other outcomes are secondary outcomes.
Discussion
It is expected that the efficacy of the two techniques in LESS, the chopstick technique vs. the cross technique, will be compared and accumulate safety data on the new techniques will be accumulated.
Trial registration
ChiCTR2000040843, registered on June 16,2020
Protocol version:
Version 2.0; Date: 2020.05.10
... [2] However, most SILS utilized expensive single-port device, either a gel port, R Port, or frequently, the SILS port from Covidien and specialized articulating instruments. [3] Several studies comparing SI laparoscopic fundoplication to the conventional multiport approaches reported an increased operation duration and high rates of multiport conversion and incisional hernia. [4] SILN + 1 can be performed entirely same as the conventional fashion, and its cosmetic outcome is permissible; it seems that SILN + 1 (Single-incision laparoscopic Nissen fundoplication with thin additional hole) is superior to P-SILN (pure single-incision laparoscopic Nissen fundoplication). ...
Advances in minimal access surgery have led to the emergence of single-incision laparoscopic surgery. Single-incision laparoscopic fundoplication for gastroesophageal reflux disease is safe and feasible in experienced hands. However, the main drawback of this technique is the increased cost factors considering the port devices and specialized instrumentation required. We did single-incision, multiple port laparoscopic Nissen fundoplication with conventional trocars and instruments.
... Compared with conventional multiport laparoscopy surgery (MPS), the benefits of LESS include reduced postoperative pain, earlier return to activities of daily living, and improved cosmesis (Marks et al., 2011). Despite these advantages, the use of LESS has not been widely adopted yet, essentially because of its intrinsic procedural complexity (Botden et al., 2011) and a significantly longer learning curve (Rao et al., 2011;Pafitanis et al., 2015). This increase in complexity might, in fact, lead to a higher procedural failure rate (for a recent metaanalysis comparing single-incision versus conventional laparoscopy outcomes in cholecystectomy, see (Trastulli et al., 2013)). ...
... exercise complexity (Peg Transfer vs. Pattern Cut performed with MPS) can also be explained by the different oculo-motor demands: the Pattern Cut exercise does not require sophisticated bimanual oculo-motor coordination Schoenthaler et al., 2015). If the surgeons keep one instrument fixed e as it was the case in our study e they can succeed with a minimal degree of freedom of movements (Pafitanis et al., 2015). Contrarily, the Peg Transfer exercise requires transferring objects in a side-to-side fashion and, therefore, constant bimanual oculomotor coordination. ...
Background: Despite the growing interest concerning the laparoendoscopic single-site surgery (LESS) procedure, LESS presents multiple difficulties and challenges that are likely to increase the surgeon's cognitive cost, in terms of both cognitive load and performance. Nevertheless, there is currently no objective index capable of assessing the surgeon cognitive cost while performing LESS. We assessed if gazebased indices might offer unique and unbiased measures to quantify LESS complexity and its cognitive cost. We expect that the assessment of surgeon's cognitive cost to improve patient safety by measuring fitnessfor-duty and reducing surgeons overload.
Methods: Using a wearable eye tracker device, we measured gaze entropy and velocity of surgical trainees and attending surgeons during two surgical procedures (LESS vs. multiport laparoscopy surgery [MPS]). None of the participants had previous experience with LESS. They performed two exercises with different complexity levels (Low: Pattern Cut vs. High: Peg Transfer). We also collected performance and subjective data.
Results: LESS caused higher cognitive demand than MPS, as indicated by increased gaze entropy in both surgical trainees and attending surgeons (exploration pattern became random). Furthermore, gaze velocity was higher (exploration pattern became more rapid) for the LESS procedure independently of the surgeon's expertise. Perceived task complexity and laparoscopic accuracy confirmed gaze-based results.
Conclusion: Gaze-based indices have great potential as objective and nonintrusive measures to assess surgeons' cognitive cost and fitness-forduty. Furthermore, gaze-based indices might play a relevant role in defining future guidelines on surgeons' examinations to mark their achievements during the entire training (e.g. analyzing surgical learning curves).
Background:
The traditional cross technique can be used to complete most Laparoendoscopic single-site surgery (LESS) procedures, but some relatively fine operations, such as vaginal stump suture, are challenging. In practice, we have introduced a novel technique named the chopstick technique and applied it to more complex operations, such as cervical cancer, and found that it contributes to delicate surgery. The efficacy and safety of two different surgical techniques in LESS hysterectomy remain to be validated.
Methods:
Patients who receive the total hysterectomy are enrolled in this RCT. Stratified randomization will be performed according to uterine size (< 10 weeks, 10-16 weeks, ≥ 16 weeks). The participants will be divided into the chopstick technique group or cross technique group to undergo LESS-TH, then be evaluated the perioperative and postoperative data, including total operation time and other time, transfer rate, estimated blood loss, surgeon fatigue, intraoperative and postoperative complications (within 8 weeks after surgery), health-related quality of life (EQ-5D), postoperative hospital stay, and hospitalization expenses. The primary outcome is the operating time for total hysterectomy under LESS, the other outcomes are secondary.
Discussion:
It is expected to compare the efficacy of the two techniques in LESS: the chopstick technique vs. the cross technique and accumulate safety data on the new techniques.
Trial registration: ChiCTR2000040843, registered on June 16,2020
Protocol version:
Version 2.0; Date: 2020.05.10
Laparoendoscopic single-site surgery (LESS) further minimizes the invasiveness of traditional laparoscopic surgery. However, the "chopstick" effect caused by the parallel arrangement of the instruments in the umbilicus is considered an obstacle indelicate operations. The purpose of this study was to introduce a new technique characterized by a double fulcrum formed by instruments, named the "chopstick" technique, which facilitates the expedient accomplishment of complicated surgeries such as LESS radical hysterectomy (LESS-RH). Seventy-three patients who underwent LESS-RH using the "chopstick" technique were retrospectively analyzed. The procedure was performed successfully in 72 patients. The median operative duration was 225 min, and the median intraoperative blood loss was 200 ml. Among the operations in the first 20 patients, intraoperative vascular injuries and bladder injury occurred in two patients and were repaired by LESS. Patients responded positively regarding minimal postoperative pain control. The score of satisfaction with the cosmetic outcome expressed by the patients was eight at discharge and nine 30 days later. In conclusion, this study presents the feasibility of accomplishing complicated procedures, such as radical hysterectomy, by LESS using the “chopstick” technique. This approach provides more options for both selected patients and surgeons.
