可弯器械和直器械在单孔腹腔镜操作中的对比研究

Comparison of Steerable and Straight Instrument in Single-incision Laparoscopic Operation

目的对比可弯器械和直器械在三种不同难度单孔腹腔镜操作任务中的表现。方法招募了12位无操作经验者参与基于腹腔镜手术训练器的操作任务,分别在三种操作环境(传统入路和直器械,单孔入路和直器械,单孔入路和可弯器械)下完成转移、穿线和缝合任务。结果训练后,参与者的操作技能显著提高(P<0.001)。在单孔转移和穿线中,直器械完成任务所需时间显著少于可弯器械(P<0.001);在单孔缝合中,直器械比可弯器械稍具优势,差异不明显(P=0.920)。结论可弯器械比直器械更适合用在复杂单孔操作中,而简单单孔操作中直器械更具优势。可弯器械复杂的结构和控制方式是制约其在单孔技术应用的主要因素。

Objective The aim of this study is to compare the performance of three- level training tasks in single- incision laparoscopic operation（ SILS） using either straight instrument or steerable instrument. Methods Twelve participants without any experiences of laparoscopic skills were recruited to perform three- level training tasks（ basic level： peg transfer,medium level： threading,advanced level： suturing） in a surgical simulator with 3 different settings： laparoscopic（ LAP） approach with straight instruments,SILS approach with straight instruments and SILS approach with steerable instruments. Results Participants＇ laparoscopic skills were significantly enhanced（ P〈0. 001） after the experiment. For peg transfer and threading in SILS,performance time using straight instruments was significantly less than that using steerable instruments（ P〈0. 001）; while for suturing in SILS,performance using straight instruments was slightly better than with that using steerable instruments（ P = 0. 920）. Conclusions Steerable instruments are more suitable for complex SILS operations while straight instruments are more suitable for basic SILS operations. Structure complexity and control method of steerable instruments are main limitations in impeding its application in SILS.