Single Incision Laparoscopic Surgery (SILS) Is Associated with Poorer Performance and Increased Surgeon Workload Compared with Standard Laparoscopy

Little is known about the effectiveness and challenges of single incision laparoscopic surgery (SILS). We hypothesized that SILS would lead to decreased performance and increased surgeon workload compared with standard laparoscopy and that the use of angulated instruments during SILS would be beneficial. General surgery residents and fellows (n = 14) voluntarily performed the Fundamentals of Laparoscopic Surgery task 1 (peg transfer) using 1) standard laparoscopic instruments and port position, 2) standard laparoscopic instruments through a SILS port, and 3) angulated instruments through a SILS port in random order. Performance was assessed with an objective score and participant workload using a modified National Aeronautics and Space Administration Task Load Index (NASA TLX) workload assessment questionnaire. Participant performance was best with standard laparoscopy followed by SILS with angulated graspers and SILS with straight instruments (scores 218 ± 26 vs 131 ± 61 vs 91 ± 57; P < 0.001, respectively). In addition, participants indicated that standard laparoscopy was easier than SILS and their workload was 35 to 53 per cent higher when performing SILS. SILS was associated with decreased performance and increased surgeon workload compared with standard laparoscopy during the performance of a simulated task. SILS performance improved when angulated instruments were used but remained inferior to standard laparoscopy. This may translate into poorer operating room efficiency and safety.