Mini-laparoscopy, laparoendoscopic single-site surgery and natural orifice transluminal endoscopic surgery-assisted laparoscopy: Novice surgeons'performance and perception in a porcine nephrectomy model

OBJECTIVE • To evaluate the perception and performance of urological surgeons when first applying scarless surgical techniques. METHODS • The study was conducted during the 2 nd Minimally Invasive Urological Surgical Week annual course in Braga, Portugal. • Fourteen attendees performed three porcine nephrectomies by using each of the following techniques: mini-laparoscopy, laparoendoscopic single-site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES)-assisted laparoscopy. • Peri-operative data were recorded, and operating performance was scored by one experienced surgeon for each working station, using a global rating scale. • The surgeons'subjective perceptions of degree of difficulty were graded and their expectations before the procedures were recorded. RESULTS • Forty-two porcine nephrectomies were performed. • There were no differences in overall operating time, or time to dissect and manage the renal vascular hilum, whereas time to gain access was faster for LESS than for mini-laparoscopy or NOTESassisted laparoscopy (mean [ SD ] 8 [ 6 ] min vs 10.2 [ 5.3 ] min vs 9.9 [ 5.3 ] min, respectively; P =0.59). • A better visualization of the surgical field was obtained with mini-laparoscopy and there was a higher degree of difficulty of bimanual dexterity for LESS, but no significant differences were found among the three techniques for any variable (operating field view: P =0.52; bimanual dexterity: P =0.49; efficiency: P =0.77; tissue handling: P =0.61; autonomy: P =0.2). • Subjective perception of the degree of difficulty trended in favour of minilaparoscopy ( P =0.17), but no significant difference was found in terms of surgeons ' impression as compared with their expectations ( P =0.34). CONCLUSIONS • When first approaching new scarless techniques, surgeons tend to perform equally well under expert guidance in the porcine model. • Mini-laparoscopy is perceived as less difficult to perform and, for all the techniques, surgeons'impressions are in line with their expectations. © 2012 THE AUTHORS.