Analysis of standard multiport versus single-site access for laparoscopic skills training

Abstract

Background: Single-site-access (SSA) laparoscopy is more challenging to perform than multiport (MP) laparoscopy. This study examined the effect of MP versus SSA skills training on laparoscopic performance using surgically naive medical students.

Methods: For the study, 40 medical students at the end of their first year were randomized into two groups. Both groups were trained in four basic laparoscopic drills (peg, rope, bean drop, pattern cutting) using a standard MP setup (group 1) and an SSA approach (group 2). The time and number of repetitions required to attain proficiency were recorded. Each group then crossed over to the alternate approach and repeated the sequence. Data are presented as mean ± standard deviation, and statistical analysis was performed using the two-tailed, unpaired t test.

Results: The total times required to attain proficiency for the SSA and MP approaches were not significantly different between the MP-trained group (234.0 ± 114.9 min) and the SSA-trained group (216.4 ± 106.5 min) (p = 0.67). The MP-trained group required less time to reach proficiency on the standard MP setup than the group using the SSA approach (119.1 ± 69.7 vs. 178.0 ± 93.4 min; p = 0.058) and significantly fewer repetitions (77.6 ± 42.6 vs. 118.8 ± 54.3; p = 0.027). The SSA-trained group required significantly less time to reach proficiency on the MP setup than the standard MP-trained group (38.4 ± 29.4 vs. 119.1 ± 69.7 min; p = 0.0013) and needed only a mean of 26.9 repetitions. When the standard MP trainees crossed over to the SSA setup, they required significantly less time to reach proficiency with the SSA approach than the SSA-trained group (114.8 ± 50.5 vs. 178.0 ± 93.4 min; p = 0.026) but required more repetitions than with the MP approach (86.2 ± 35.2 vs. 77.6 ± 42.6; nonsignificant difference).

Conclusions: Laparoscopic SSA skills training results in longer times and more repetitions to achieve proficiency than MP training, but the skills acquired transfer well to the MP approach.

Fig. 1

Study design

Fig. 2

Skills trainer box set-up. A) Multi-port configuration. B) Single site access port configuration.

Fig. 3

Mean times to reach proficiency for the four skills tasks for Phase I (left panel) and I (right panel) of the study. MP = multi=port, SSA = single site access. * p<0.001 between groups for a given task.

Fig. 4

Mean number of repetitions to reach proficiency for the four skills tasks for Phase I (left panel)and II (right panel). MP = multi=port, SSA = single site access. * p<0.001 between groups for a given task.

Fig. 5

Total combined time (left panel) and number of repetitions (right panel) to proficiency for both phases of the study for the multi-port (MP) and SSA (single site access) groups.