Maneuverability of the Scope and Instruments within Three Different Single-Incision Laparoscopic Ports: An Experimental Pilot Study

SIMPLE SUMMARY: Single-port access systems, used to perform endoscopic surgery through a single incision, are currently used in many human and veterinary surgeries. These systems present some technical challenges as they offer limited space for manipulation. No objective study has evaluated the degree of possible movement within different single-port access systems. This study aimed to measure and compare the possible movements of the endoscope and instruments within three single-port access systems: the Covidien SILS-port, Storz Endocone, and glove port. The glove port consists of a surgical glove and an O-ring retractor. A clear acrylic box with artificial skin was used to mimic the abdominal wall and cavity. A motion capture system with 18 cameras was used to trace the possible movements of the endoscope. The volume of the cone-shaped three-dimensional figure described by the scope when circled 360° was used to compare maneuverability across the three systems. The glove port showed higher maneuverability than the two commercially available ports when an endoscope alone, or an endoscope and instrument, was or were inserted. A higher degree of maneuverability is positively associated with easier handling of the endoscope and instruments during surgical procedures. The findings of this study may benefit students and young professionals by helping them to select an easy-to-use single-port access system when beginning single-incision endoscopic surgery. ABSTRACT: Single-port access systems (SPASs) are currently used in human and veterinary surgeries. However, they pose technical challenges, such as instrument crowding, intra- and extracorporeal instrument collision, and reduced maneuverability. Studies comparing the maneuverability of the scopes and instruments in different SPASs are lacking. This study aimed to compare the maneuverability of three different SPASs: the Covidien SILS-port, Storz Endocone, and glove port. A clear acrylic box with artificial skin placed at the bottom was used to mimic the abdominal wall and cavity. The three SPASs were placed from below, and a 10-mm endoscope and 5-mm instrument were introduced. A motion analysis system consisting of 18 cameras and motion analysis software were used to track the movement of the endoscope and instrument, to determine the volume of the cone-shaped, three-dimensional figures over which movement was possible, with higher values indicating greater maneuverability. The Mann–Whitney U test was used for the analysis. The maneuverability of the endoscope alone was significantly higher in the glove port system than in the other two SPASs. When inserting an additional instrument, the maneuverability significantly decreased in the SILS-port and Endocone, but not in the glove port. The highest maneuverability overall was found in the glove port.