Comparison of the Effect of Instrument Type on Transanal Endoscopic Surgery Learning Curves. Issue 4 (August 2016)

• Record Type: Journal Article
• Authors: Teitelbaum, Ezra N.; Arafat, Fahd O.; Boller, Anne-Marie
• Is Part Of: Surgical laparoscopy endoscopy & percutaneous techniques. Volume 26:Issue 4(2016)
• Publication Date: 2016-08
• Subjects: transanal endoscopic surgery -- transanal endoscopic microsurgery -- laparoscopic surgery -- surgical instruments -- learning curve; Endoscopic surgery -- Periodicals; Laparoscopic surgery -- Periodicals; Endoscopy -- Periodicals; Laparoscopy -- Periodicals; 617.550597
• DOI: 10.1097/SLE.0000000000000300
• Languages: English
• ISSNs: 1530-4515

Abstract

Abstract : Background: Transanal endoscopic surgery (TES) can be technically difficult due to the constraints of operating through a narrow proctoscope channel. In this study, we compared the performance of surgical novices using instruments with and without articulating shafts to perform a simulated TES task. Methods: Medical students each performed 10 repetitions of the Fundamentals of Laparoscopic Surgery circle-cut task. Participants were randomized into 3 groups: 2 performed the task through a TES proctoscope using scissors with either a rigid (TES-R) or articulating (TES-A) shaft. The third group performed the task laparoscopically (LAP). Results: A total of 31 medical students participated. The LAP group had a faster mean task time than both the TES-R and TES-A groups (LAP 201±120 s vs. TES-R 362±212 s and TES-A 405±212 s, both P <0.001). The TES-R group made more errors (ie, deviation from a perfect circle) than both the other groups. The TES-R group adjusted the proctoscope position during more repetitions than the TES-A group. Conclusions: Students had faster task times when operating laparoscopically than through a TES protoscope. Task times were similar between the TES groups using scissors with articulating and rigid shafts; however, use of the articulating instruments resulted in fewer errors and less need to adjust proctoscope position.