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Background The rising interest towards minimally invasive surgery has led to the introduction of laparo-endoscopic single site (LESS) surgery as the natural evolution of conventional multiport laparoscopy. However, this new surgical approach is hampered with peculiar technical difficulties. The SPIDER surgical system has been developed in the attempt to overcome some of these challenges. Our study aimed to compare standard laparoscopy and SPIDER technical performance on a surgical simulator, using standardized tasks from the Fundamentals of Laparoscopic Surgery (FLS). Methods Twenty participants were divided into two groups based on their surgical laparoscopic experience: 10 PGY1 residents were included in the inexperienced group and 10 laparoscopists in the experienced group. Participants performed the FLS pegboard transfers task and pattern cutting task on a laparoscopic box trainer. Objective task scores and subjective questionnaire rating scales were used to compare conventional laparoscopy and SPIDER surgical system. Results Both groups performed significantly better in the FLS scores on the standard laparoscopic simulator compared to the SPIDER. Inexperienced group: Task 1 scores (median 252.5 vs. 228.5; p = 0.007); Task 2 scores (median 270.5 vs. 219.0; p = 0.005). Experienced group: Task 1 scores (median 411.5 vs. 309.5; p = 0.005); Task 2 scores (median 418.0 vs. 331.5; p = 0.007). Same aspects were highlighted for the subjective evaluations, except for the inexperienced surgeons who found both devices equivalent in terms of ease of use only in the peg transfer task. Conclusions Even though the SPIDER is an innovative and promising device, our study proved that it is more challenging than conventional laparoscopy in a population with different degrees of surgical experience. We presume that a possible way to overcome such challenges could be the development of tailored training programs through simulation methods. This may represent an effective way to deliver training, achieve mastery and skills and prepare surgeons for their future clinical experience.

BackgroundsThe suspicion of a hyperparatiroidism is mostly guidedby the finding of an increase in serum calcium levels byroutine measurements. Primary hyperparathyroidism is acommon disease occurring in 0.2 to 0.5% of the popula-tion. The incidence in the United States is approxi-mately 100000 new cases per year and increases withage affecting up to 2% of elderly people [1].Materials and methodsFrom January 1995 to December 2009, 172 patientsunderwent operations for Hyperparathyroidism, 130 ofthese were Primary Hyperparathyroidism at our Depart-ment of General Surgery. Patients were divided into twogroups: patients of≤ 69 years old (Group A) andpatients of ≥ 70 years old (Group B). The following vari-ables were studied: demographic characteristics, co-mor-bidities, preoperative symptoms, laboratory values,operative procedures, postoperative complications andanatomo -pathological findings.ResultsGroup A: 110 patients operated 25 were male, 85 werefemale with a M:F ratio of 0.3:1. Mean age at admissionwas52.4(SD±12.9).Wereportedamorbidityrateof5.4% (6 patients) and a mortality rate of 0%. Group B:20 patients operated 6 were male, 16 were female with aM:F ratio of 0.25:1. Mean age at admission was 74.2 (SD±3.7). We reported a morbidity rate of 5% (1 patient)and mortality rate 0%.ConclusionsElderly patients with Hyperparathyroidism present avariety of symptoms that are often different from thoseseen in younger patients. They are more likely to mani-fest fatigue and psychiatric symptoms that are difficultto distinguish from those due to their age, therefore inthe majority of cases the suspicion of hyperparathyroid-ism is guided by the finding of an increase in serum cal-cium levels on a routine measurement. If serum calciumlevel is high or if hypercalcaemia is discovered, measure-ment of PTH confirms the diagnosis [2,3]. Cervicotomyand parathyroidectomy is still to be considered as thetreatment of choice in elderly patients with primaryhyperparathyroidism.