Comparison of a single-access glove port with a SILS™ port in a surgical simulator model using MISTELS

Abstract

Background: Recent advances in laparoscopy both in human and veterinary medicine have looked at means of being less invasive by using single-port access surgery as opposed to multiport access surgery. The glove port has gained popularity as a cost-effective alternative to commercially available single-port access devices. The primary aim of this study was to compare the glove port to the SILS™ port in a simulator model using the first two MISTELS (McGill inanimate system for training and evaluation of laparoscopic skills) tasks (peg transfer and pattern cutting).

Methods: Twenty-two novices were enrolled in this experimental study. Each participant had 60 min to practise both MISTELS tasks using two-port laparoscopy. Thereafter participants performed both tasks using the glove and SILS™ port with scores being calculated based on task completion time and errors. Higher scores were indicative of better performance. Participants were assigned into two groups with the starting order of the single ports being randomly selected. A self-evaluation questionnaire with three questions was completed by each participant after testing, rating each port.

Results: Significantly (p < 0.05) higher scores were achieved using the glove port compared to the SILS™ port when performing both tasks. The glove port was subjectively evaluated as easier to use with more manoeuvrability of the instruments than the SILS™ port.

Implications of the study: The glove port's improved manoeuvrability and ease of use make it a cost-effective alternative to the SILS™ port, for use in single-port laparoscopic veterinary surgery.

Keywords: Glove port; Laparoscopy; MISTELS; SILS™ port; Simulation; Single port.

Fig. 1

The left of the image is the SILS™ port and to the right of the image is the glove port. An ALEXIS® wound protector retractor is attached to a glove with slim trocars placed through holes made in the fingers of the glove

Fig. 2

Official VALS box trainer on the right of the image and single access port box trainer with attached SILS™ port on the left of the image

Fig. 3

Single access port box trainer with attached glove port

Fig. 4

Top of the image is the Peg Board with 6 colour triangles. Bottom of the image is the gauze swab attached to a Styrofoam board by alligator clips

Fig. 5

Box plot graph of the peg transfer task comparing the normalised scores achieved by the 22 participants using both the glove port and the SILS™ port. The Y-axis represents the normalised scores. The boxes represent values between the first quartile (Q1) and the third quartile (Q3). Whiskers ranging from Q1 to the minimum and from Q3 to the maximum. The bold line shows the median. The first box plot on the X-axis represents the glove port and the second box plot represents the SILS™ port. The p-value indicates the significance of the difference between the two ports using the general linear model

Fig. 6

Box plot graph of the pattern cutting task comparing the normalised scores achieved by the 22 participants using both the glove port and the SILS™ port. The Y-axis represents the normalised scores. The boxes represent values between the first quartile (Q1) and the third quartile (Q3). Whiskers ranging from Q1 to the minimum and from Q3 to the maximum. The bold line shows the median. The first box plot on the X-axis represents the glove port and the second box plot represents the SILS™ port. The p-value indicates the significance of the difference between the two ports using the general linear model