Background:
With this study we aimed at analyzing the performance of surgeons with experience in LESS procedures during the completion of intracorporeal suturing maneuvers on simulator.

Material and Methods:
Four surgeons with experience in LESS surgery were included on this study, and asked to complete two sutures of increasing difficulty level (lineal closure with 6 sutures and circular anastomosis with 8 sutures) on simulator and on ex vivo porcine stomach and uretrovesical junctions. The elected access device was SILSTM Port (Covidien, Mansfield, MA, USA) during the 7 practice sessions, over a period of 14 weeks. Performance was objectively assessed by registering total completion time and OSATS score. Each task was limited to 15 minutes.

Result:
From first (T1) to last (T7) session surgeons significantly improved their performance score on both linear (T1 0.83±0.008 vs. T7 0.89±0.06, p<0.05) and circular (T1 0.80±0.08 vs. T7 0.93±0.06, p=0.032) anastomoses. Concerning completion time per suture, statistically significant differences were also observed in the same time period for both sutures: linear T1 2.74±1.01min vs. T7 2.14±1.06min, p<0.05; circular T1 3.75±1.62min vs. T7 2.04±0.82min, p=0.006.

Conclusion:
Apart from successfully performing difficult maneuvers using LESS approach in an reasonable amount of time, we observed that with regulated practice it is possible to learn and further improve skills in this type of surgery, hopefully further improving quality and safety of surgical treatment.