Surgical endoscopy
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Randomized Controlled Trial Comparative Study
Effect of training and instrument type on performance in single-incision laparoscopy: results of a randomized comparison using a surgical simulator.
Single-incision laparoscopy (SIL) is potentially less invasive compared with standard laparoscopic surgery (LAP); however, it may be more technically challenging and have a longer learning curve. A two-phase study was conducted to examine the performance of standardized tasks on a surgical simulator by novices during a distributed training period. Phase 1 examined the effect of LAP-specific or SIL-specific training on skill acquisition for both techniques. Phase 2 compared the effectiveness and learning curves of additional instrument types for SIL (straight [STR] vs. dynamic articulating [D-ART]). ⋯ LAP technique results in superior task performance with a shorter learning curve compared with SIL technique during a standardized training period. SIL-specific simulator training is better than LAP training alone to improve SIL performance. Neither S-ART nor D-ART instruments for SIL are associated with improved performance or shorter learning curve compared with STR instruments.
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Previous studies have shown different pain characteristics in different types of laparoscopic operations, but pain pattern has not been studied in detail after laparoscopic inguinal hernia repair. To optimise preoperative patient information and postoperative analgesic treatment the present study investigated postoperative pain in terms of time course, pain intensity and individual pain components during the first 4 days after transabdominal preperitoneal hernia repair (TAPP). ⋯ Pain was most intense 3 h after the operation and declined to low levels within the first 3 days. Visceral pain was by far the dominating pain component compared with incisional and shoulder pain.