Multi-DOF (Degree of Freedom) Articulating Laparoscopic Instrument is an Effective Device in Performing Challenging Sutures

Abstract

Purpose: Although laparoscopic surgery had been performed in clinical practice for over 30 years, there has not been much improvement on instruments. Several articulating laparoscopic instruments have been developed including the robotic system. A new multi-degree of freedom (DOF) articulating laparoscopic device has been developed. We compared the ability to perform challenging sutures between the new device and the robotic system.

Methods: Five experienced surgeons with over 100 laparoscopic surgery cases performed the suture task with both instruments. Everyone was new at articulating instruments including a robotic system. The suturing task consisted of two vertical sutures, downward and upward vertical direction. The duration of needle grabbing, first surgical tie, square tie, and the final reverse tie was measured.

Results: When doing the downward suture, the median time to complete the suture was 127 vs. 136 seconds for ArtiSential® and the robot, respectively (p=0.754). Other measurements such as needle grabbing, first tie, second tie and final knot did not show any significant difference between the two instruments. Upward suture also did not show a significant difference. The total completion time was 127 vs. 112 seconds for for ArtiSential® and the robot, respectively (p=0.675). Time taken in each interval did not show any significant difference.

Conclusion: Both instruments performed the suturing tasks with no difference in duration. ArtiSential® can be mixed up with usual instruments. Surgeons can choose any device, but when articulation is needed, ArtiSential® could be an alternative choice to the robotic system.

Keywords: Articulation; Instrument; Laparoscopy; Robotics; Suture.

Conflict of interest statement

CONFLICT OF INTEREST Yes (ArtiSential instruments were provided by LivsmedTM, Korea).

Copyright © 2019 The Journal of Minimally Invasive Surgery.

Figures

Fig. 1

ArtiSential® instrument handle. The thumb and the index finger, mainly used for grabbing, goes into the two holes on the handle. The movement of this handle and the end tool shows identical motion.

Fig. 2

ArtiSential® instrument hand-end tool coordination. The movement of the thumb, index finger and the wrist perfectly match the movement of the end tool.

Fig. 3

(A) ArtiSential® Bipolar Fenestrated Grasper, (B) ArtiSential® Needle Holder.

Fig. 4

Suture task pad. The matching vertical dots are targets for up and down vertical sutures.

Fig. 5

(A) Setting for suture task with ArtiSential® instruments. (B) Robotic setting for suture task with da Vinci® surgical system.