Single Port / Incision Laparoscopic Surgery: A National Survey of Awareness, Experience and Opinions

Haroon Rehman , Edward Fitzgerald , Irfan Ahmed

1 2 3

Medical student University of Aberdeen, 2 General Surgery Registrar, 3 HPB Consultant Surgeon, Aberdeen Royal Infirmary
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Aims:
Single incision laparoscopic surgery (SPILS) is a recent innovation in minimally invasive surgery whereby operations are performed through a single point of entry. Despite the relative paucity of clinical data, the procedure is increasingly being used to minimise scarring and pain associated with the multiple entry points of traditional laparoscopic surgery. This study aimed to analyse the awareness, experience and opinions of British surgeons regarding SPILS.

Figure 1: Frequency distribution of speciality of participants

Speciality
General Surgery 86.0% Urology 3.8%

Figure 2: Frequency distribution of all participants according to training grade

Gynaecology 3.8% Other 9.3%

Methods:
Electronic, 13-item, self-administered, anonymous questionnaire survey distributed via national / regional surgical mailing lists and websites. Results were collated and analysed with SPSS v17.0 for Windows (SPSS, Inc, Chicago, IL). Figure 3: Operative experience

Table 1: Operative experience by trading grade Have you assisted or performed SPILS Yes Level of training: FY1-2 ST1-2 ST3-5 ST5-8 Post CCT Non training grade Consultant 1 (.8%) 9 (7.3%) 27 (22.0%) 27 (22.0%) 16 (13.0%) 3 (2.4%) 40 (32.5%) No 2 (1.0%) 17 (8.2%) 53 (25.6%) 78 (37.7%) 15 (7.2%) 11 (5.3%) 31 (15.0%)

Results:
342 fully completed responses received, including 72 (21%) Consultants and 189 (55%) higher surgical trainees; the majority were general surgeons (Fig 1). Overall 330 (96.5%) were aware of SPILS; there was no significant difference in awareness between grades (Fig 2). Only 37% had assisted or performed SPILS procedures. More consultants performed these than trainees (56.3 vs 32.0%, p<0.05) (Table 1). Operative experience was limited, with only 6% of those undertaking SPILS performing 25 procedures, and 60% performing 5 (Fig 3). 61.4% believed SPILS takes longer to perform, and 32.8% believed it has higher complication rate. Factors cited as limiting uptake included: lack of evidence (70%), insufficient training opportunities (78%), incorrect instrumentation (70%), increased cost (62%), and hospital policy (44.5%). Patient preference was considered to have negatively affected SPILS uptake by only 9% of respondents. A greater proportion of trainees (94.6% vs 78.9%) felt there were insufficient SPILS training opportunities (p=0.001) (Table 2).

Table 2: Participant opinions on reasons for low uptake Strongly Agree Agree (N (%)) Lack of effectiveness Difficult to learn Lack of interest from trainees Prolonged operating time Increased Risk of Complication Not enough training opportunities Lack of correct instrumentation Patient preference Conservatism in British Health System Hospital Policy Increased Costs 74 (21.6) 32 (9.4) 14 (4.1) 44 (12.9) 29 (8.5) 101 (29.5) 78 (22.8) 7 (2.0) 39 (11.4) 39 (11.4) 70 (20.5) 154 (45.0) 114 (33.3) 65 (19.0) 166 (48.5) 83 (24.3) 155 (45.3) 153 (44.7) 24 (7.0) 119 (34.8) 108 (31.6) 135 (39.5) Neither Agree nor Disagree 83 (24.3) 102 (29.8) 101 (29.5) 75 (21.9) 138 (40.4) 50 (14.6) 63 (18.4) 158 (46.2) 101 (29.5) 130 (38.0) 94 (27.5) Disagree 16 (4.7) 70 (20.5) 121 (35.4) 36 (10.5) 67 (19.6) 20 (5.8) 29 (8.5) 118 (34.5) 56 (16.4) 47 (13.7) 27 (7.9) Strongly Disagree 3 (0.9) 12 (3.5) 29 (8.5) 9 (2.6) 13 (3.8) 4 (1.2) 7 (2.0) 23 (6.7) 15 (4.4) 6 (1.8) 4 (1.2)

Conclusions:
Although awareness of SPILS is high, operative experience is limited and negative perceptions regarding operating time and complications remain. The findings suggest future uptake relies strongly on the availability of evidence, training, instrumentation and reduced costs. Scientific studies are still awaited to assess effectiveness and provide clinical and economic evaluation.