Background:
Existing comparisons between the different LESS ports usually focus on economic cost and technical aspects rather than basing assertions on objectively assessed trials. We aimed to objectively compare the use of three different LESS access devices.

Material and Methods:
20 subjects were recruited to carry out two tasks on simulator: cut on a patented template, and intracorporeal interrupted sutures on porcine stomach. Both tasks were repeated during 9 consecutive sessions. Total task completion time was registered and performance was objectively assessed. Evaluations were carried out blindly by two expert raters.

Result:
Improvement was observed with all devices total completion times for the cut task, and significantly so with the use of SILS (p=0.017). SILS obtained the highest score, followed by GPN and XCN, without statistical significance. XCN showed a non significant improvement in performance from the first to the last week. On intracorporeal suturing, XCN demanded significant longer completion times when compared to SILS (p<0.001) and to GPN (p<0.001). There was significant improvement of performance times with SILS (p=0.003), GPN (p<0.001), and XCN (p<0.001). There was significant improvement in performance with all LESS access devices from the first to the last week of training (SILS: p=0.003; GPN: p=0.001; XCN: p<0.001).

Conclusion:
There is no clear benefit of one LESS access device over the other. We advise surgeons to focus on specific procedures and patient characteristics and select the most appropriate LESS access device maintaining patients’ and procedural safety standards.