Comparison of single access devices during cut and suturing tasks on simulator.

BACKGROUND: Published comparisons of the different available laparoendoscopic single-site surgery (LESS) devices focused on its economic cost and technical aspects. With this study, we aimed to objectively compare the use of three different LESS access devices in controlled experimental tasks. MATERIALS AND METHODS: Twenty subjects participated in simulator trials. A cut and an intracorporeal suturing task were carried out. Three single access devices (SILS: SILS(TM) Port, GPN. GelPOINT Advanced Access Platform, and XCN: XCONE) were used according to a randomized nine-session schedule. Completion time was registered and performance objectively assessed with task-specific rating scales. Two blinded expert raters worked over video recordings of the hands-on sessions. RESULTS: Participants showed improvement with all devices on total cut completion times and significantly for SILS (P = 0.017). The GPN decreased its adapted Global Rating Scale score (P = 0.002) from the first (W1) to the last week (W9). On the suture task, XCN constituted the device with longer completion times compared with SILS (P < 0.001) and to GPN (P < 0.001). There was significant improvement in times from W1 to W9 with XCN (P < 0.001), SILS (P = 0.003), and GPN (P < 0.001). On average summative score, we observed significant improvement in performance with all devices from W1 to W9 (SILS: P = 0.003; GPN: P = 0.001; and XCN: P < 0.001). CONCLUSIONS: Although we advise surgeons to focus on the specific procedures and patient characteristics to select the most adequate access device to maintain procedural safety standards, single-use devices appear to confer an easier adaptation to LESS surgery.

Performance analysis on physical simulator of four different instrument setups in laparo-endoscopic single-site (LESS) surgery.

BACKGROUND: Over the past decades, minimally invasive surgery has undergone continuous development due to the demand for scarless results, with laparo-endoscopic single-site (LESS) surgery constituting one of today's most favored alternatives. In this study, we aim to assess the relative technical difficulty and performance benefits of dynamic articulating and pre-bent instruments, either combined with conventional laparoscopic tools or not, during the completion of two basic tasks hands-on simulator. METHODS: A total of 20 surgeons were included and performed two basic simulator tasks-coordination and cutting-carried out using four different combinations of LESS-designed and straight conventional laparoscopy instruments. Assessment took place before and after the completion of a 14-week training program. Performance data were objectively analyzed over video recordings with an adapted global rating scale (a-GRS) for performance evaluation, combined with a registry of total trial completion time. RESULTS: In the coordination task, the worst performance scores (p < 0.001) and longest completion times (p < 0.001 on first assessment and p < 0.01 on last assessment) were obtained with the two dynamic articulating tip instruments. On the cut trials, no significant differences between the different setups were found in a-GRS scores. The two dynamic articulating tip instruments also constituted the most time-demanding setup on both assessment trials (p < 0.05). The use of two dynamic articulating tip instruments showed significant improvement with training in all measured parameters except for performance in the cut task, in which the increase in a-GRS score was not significant. CONCLUSIONS: We conclude that the least adequate instrument set for initiation in LESS surgery is the one that combines two dynamic articulating tip instruments, as this has consistently obtained the worst results in all trials. Further data on more complex tasks and on a complete learning and skills-acquisition program must be obtained to confirm these findings.

[Training and research in urologic laparoscopic surgery. Design of training programs and experimental models of renal tumor]. / Formación e investigación en cirugía laparoscópica urológica. Diseño de programas formativos y modelos experimentales de tumor renal.

We present our experience with surgical training programs development for basic and advanced laparoscopic urological surgery. Both training programs consist of 21 and 28 hours respectively. Basic surgical programs start with general knowledge of ergonomics and instrumentation, there after, attendants acquire basic skills on physical simulator. Posteriorly, techniques on animal model are undertaken, always assisted by an expert. Advanced activities start with surgical tasks on physical simulator. Posteriorly, reconstructive urological surgical techniques are undertaken on animal model, focused on partial nephrectomy, and always assisted by an expert tutor. We present our results on exophytic renal tumour model creation based chromatic Alginate.

Formación e investigación en cirugía laparoscópica urológica. Diseño de programas formativos y modelos experimentales de tumor renal / Training and research in urologic laparoscopic surgery. Design of training programs and experimental models of renal tumor

Presentamos nuestra experiencia en el desarrollo de programas de formación en cirugía laparoscópica urológica básica y avanzada. Ambos modelos formativos constan de 21 y 28 horas de duración respectivamente. El de tipo básico comienza con el conocimiento de aspectos generales de la ergonomía y del instrumental, tras lo cual los alumnos adquieren destrezas básicas mediante la práctica en simulador físico. Posteriormente se acometen las técnicas en modelo animal, siempre asistidos por profesorado experto. Las actividades avanzadas comienzan con prácticas directas en simulador físico. Posteriormente se acometen técnicas de urología reconstructiva en modelo animal, dando especial importancia a la nefrectomía parcial, siempre asistidos por profesorado experto. Así mismo presentamos los resultados de nuestra experiencia con un modelo basado en alginato cromático para la creación de pseudotumores exofíticos renales(AU)

We present our experience with surgical training programs development for basic and advanced laparoscopic urological surgery. Both training programs consist of 21 and 28 hours respectively. Basic surgical programs start with general knowledge of ergonomics and instrumentation, there after, attendants acquire basic skills on physical simulator. Posteriorly, techniques on animal model are undertaken, always assisted by an expert. Advanced activities start with surgical tasks on physical simulator. Posteriorly, reconstructive urological surgical techniques are undertaken on animal model, focused on partial nephrectomy, and always assisted by an expert tutor. We present our results on exophytic renal tumour model creation based chromatic Alginate(AU)

Ergonomía en cirugía laparoscópica y su importancia en la formación quirúrgica / Ergonomics in laparoscopic surgery and its importance in surgical training

A pesar de las múltiples ventajas que la cirugía laparoscópica conlleva para los pacientes, entraña una serie de riesgos para el cirujano, relacionados con la reducción de la libertad de movimientos y la adopción de posturas forzadas, ocasionando mayor fatiga muscular en comparación con la cirugía convencional. En cirugía laparoscópica son escasas las referencias sobre la implementación de programas de formación en ergonomía, a pesar de las numerosas ventajas que ha demostrado en otras disciplinas. La aplicación de criterios ergonómicos en el ámbito quirúrgico supondría grandes beneficios, tanto para los cirujanos como para los pacientes. En este trabajo pretendemos revisar la bibliografía existente y nuestra experiencia, para aportar al cirujano unas guías ergonómicas de posicionamiento corporal y colocación de equipos. Asimismo, presentamos el modelo de formación basado en ergonomía que hemos implementado en las actividades de formación llevadas a cabo en nuestro Centro (AU)

Despite the many advantages that laparoscopic surgery has for patients, it involves a series of risks for the surgeon. These are related to the reduced freedom of movement and forced postures which lead to greater muscle fatigue than with conventional surgery. In laparoscopic surgery there are few references on the introduction of training programs in ergonomics, despite the numerous advantages demonstrated in other disciplines. The application of ergonomic criteria in the surgical field could have great benefits, both for surgeons and patients. In this work we attempt to review the existing literature and our experience to provide the surgeon with some ergonomic guidelines for body stance and positioning of equipment. We also present a training model based on ergonomics which we have introduced into the training activities carried out in our Centre (AU)

[Ergonomics in laparoscopic surgery and its importance in surgical training]. / Ergonomía en cirugía laparoscópica y su importancia en la formación quirúrgica.

Despite the many advantages that laparoscopic surgery has for patients, it involves a series of risks for the surgeon. These are related to the reduced freedom of movement and forced postures which lead to greater muscle fatigue than with conventional surgery. In laparoscopic surgery there are few references on the introduction of training programs in ergonomics, despite the numerous advantages demonstrated in other disciplines. The application of ergonomic criteria in the surgical field could have great benefits, both for surgeons and patients. In this work we attempt to review the existing literature and our experience to provide the surgeon with some ergonomic guidelines for body stance and positioning of equipment. We also present a training model based on ergonomics which we have introduced into the training activities carried out in our Centre.

Diseño del entrenamiento y la adquisición de habilidades técnicas en la colecistectomía transvaginal (NOTES) / Training design and improvement of technical skills in the transvaginal cholecystectomy (NOTES)

Introducción: El reciente escenario quirúrgico de la cirugía a través de orificios naturales o cirugía sin cicatrices» requiere que el cirujano adquiera nuevas habilidades técnicas. Presentamos la experiencia inicial del Centro de Cirugía de Mínima Invasión Jesús Usón (CCMIJU), en la fase de diseño y desarrollo de un programa de formación quirúrgica con abordaje por orificios naturales para la adquisición de habilidades y destrezas quirúrgicas, basado en las pruebas preliminares realizadas en simuladores y en modelo porcino. Material y métodos: Tras un entrenamiento inicial en simulador laparoscópico, fueron intervenidos 7 animales hembras de la especie porcina con pesos de 35–40kg. En todos los animales se completó el abordaje transvaginal mediante un gastroscopio con un solo canal. Tras el acceso al abdomen, se procedió a la exploración de la cavidad abdominal y se concluyó con la realización de la colecistectomía endoscópica. Resultados: En 6 de los casos se completó con éxito la colecistectomía endoscópica. En un animal el procedimiento se detuvo por problemas técnicos relacionados con la orientación del extremo del endoscopio. El tiempo quirúrgico medio fue 107,14 (intervalo, 80–150)min. El abordaje transvaginal permitió la exploración abdominal y la disección, la ligadura y la sección del conducto cístico y la arteria cística. Tras la colecistectomía la vesícula fue extraída a través de la vagina. Tras el procedimiento la necropsia no reveló lesiones en los órganos abdominales ni complicaciones intraoperatorias. Conclusiones: La colecistectomía transvaginal pura es un procedimiento factible y reproducible en modelo animal. Es necesario un modelo de formación sistematizado, que incluya tanto conocimientos fisiopatológicos como técnicos, para trasladar de forma segura estos procedimientos a la práctica clínica (AU)

Introduction: The current surgical scenario of the surgery through natural orifices or no-scar surgery» requires acquiring new technical skills by the surgeon. We introduce the initial experience of the Minimally Invasive Surgery Centre Jesús Usón (MISCJU) in the design and setting-up of a surgical training programme using the the natural orifices approach for the acquisition of surgical skills and abilities, based on the preliminary trials in simulators and a pig model. Material and methods: After initial training, using a laparoscopic pelvic-trainer, 7 female pigs, with weights between 35–40kg, were operated on. The transvaginal approach was completed using a one-channel gastroscope in all the animals. After accessing the abdomen, the abdominal cavity was explored, and the surgery was concluded with the endoscopic cholecystectomy. Results: Endoscopic cholecystectomy was successfully completed in 6 cases. In one of the animals, the procedure was stopped because of technical problems regarding the endoscope leaning to one end. The average surgical time was 107.14min (range, 80–150min). The transvaginal approach enabled the abdominal to be explored and the dissection, ligature and section of the cystic duct and the cystic artery. After cholecystectomy, the gallbladder was extracted through the vagina. After the procedure necropsy did not reveal intra-abdominal lesions or intraoperative complications. Conclusions: The pure transvaginal cholecystectomy is a feasible and reproducible procedure in the animal model. A systematized training model, which includes physiopathology knowledge as well as technical knowledge, in order to translate these procedures to the clinical practice in a safe way, is needed (AU)

[Training design and improvement of technical skills in the transvaginal cholecystectomy (NOTES)]. / Diseño del entrenamiento y la adquisición de habilidades técnicas en la colecistectomía transvaginal (NOTES).

INTRODUCTION: The current surgical scenario of the surgery through natural orifices or <> requires acquiring new technical skills by the surgeon. We introduce the initial experience of the Minimally Invasive Surgery Centre Jesús Usón (MISCJU) in the design and setting-up of a surgical training programme using the the natural orifices approach for the acquisition of surgical skills and abilities, based on the preliminary trials in simulators and a pig model. MATERIAL AND METHODS: After initial training, using a laparoscopic pelvic-trainer, 7 female pigs, with weights between 35-40 kg, were operated on. The transvaginal approach was completed using a one-channel gastroscope in all the animals. After accessing the abdomen, the abdominal cavity was explored, and the surgery was concluded with the endoscopic cholecystectomy. RESULTS: Endoscopic cholecystectomy was successfully completed in 6 cases. In one of the animals, the procedure was stopped because of technical problems regarding the endoscope leaning to one end. The average surgical time was 107.14 min (range, 80-150 min). The transvaginal approach enabled the abdominal to be explored and the dissection, ligature and section of the cystic duct and the cystic artery. After cholecystectomy, the gallbladder was extracted through the vagina. After the procedure necropsy did not reveal intra-abdominal lesions or intraoperative complications. CONCLUSIONS: The pure transvaginal cholecystectomy is a feasible and reproducible procedure in the animal model. A systematized training model, which includes physiopathology knowledge as well as technical knowledge, in order to translate these procedures to the clinical practice in a safe way, is needed.