A triangulating operating platform enhances bimanual performance and reduces surgical workload in single-incision...

Area of Science:

• Minimally Invasive Surgery
• Surgical Technology
• Laparoscopic Surgery

Background:

• Single-site laparoscopy (SSL) aims to minimize surgical impact but faces challenges like instrument collision.
• These collisions can hinder bimanual coordination and increase surgeon cognitive load.
• A novel single-port, triangulating surgical platform (SPSP) was developed to address these SSL limitations.

Purpose of the Study:

• To evaluate the performance impact of SSL with crossed instruments versus a novel SPSP.
• To compare surgeon mental workload between SSL, SPSP, and standard laparoscopy (SL).
• To assess the efficacy of the SPSP in improving bimanual coordination during intracorporeal suturing.

Main Methods:

• Fourteen skilled laparoscopic surgeons performed intracorporeal suturing using SSL with crossed instruments, SPSP, and SL (control).
• Surgical performance was assessed using validated scoring methods.
• Surgeon mental workload was quantified using the National Aeronautics and Space Administration Task Load Index.

Main Results:

• SSL with crossed instruments significantly reduced performance by over 50% compared to SL (p < 0.001).
• The SPSP significantly enhanced bimanual coordination (p < 0.001).
• Surgeons reported lower mental workload when using the SPSP, which offers true-right and true-left instrument manipulation.

Conclusions:

• SSL significantly impairs fundamental laparoscopic skills, posing a barrier to its widespread adoption.
• The SPSP demonstrates potential to overcome SSL's inherent challenges by providing intuitive instrument control.
• Surgical platforms enabling true left/right instrument manipulation may enhance SSL effectiveness and acceptance.