Is it Beneficial to Utilize an Articulating Instrument in Single-Port Laparoscopic Gastrectomy?

Abstract

Purpose: As the number of gastric cancer survivors is increasing and their quality of life after surgery is being emphasized, single-port surgery is emerging as an alternative to conventional gastrectomy. A novel multi-degree-of-freedom (DOF) articulating device, the ArtiSential® device (LivsMed, Seongnam, Korea), was designed to allow more intuitive and meticulous control for surgeons facing ergonomic difficulties with conventional tools. In this study, we evaluated the feasibility of this new device during single-port laparoscopic distal gastrectomy (SP-LDG) for early gastric cancer (EGC) patients.

Materials and methods: Consecutive patients diagnosed with EGC who underwent SP-LDG with ArtiSential® (LivsMed) graspers between April 2018 and August 2020 were enrolled in the study. The clinical outcomes were compared with those of a control group, in which prebent graspers (Olympus Medical Systems Corp) were used for the same procedures.

Results: Seventeen patients were enrolled in the ArtiSential® group. There was no significant difference in operative time (205.4±6.0 vs. 218.1±9.9 minutes, P= 0.270) or the quality of surgery, in terms of the number of retrieved lymph nodes (49.5±3.5 vs. 45.9±4.0, P=0.473), length of hospital stay (15.4±2.0 vs. 12.4±1.3 days, P=0.588), and postoperative complications (40.0% vs. 41.2%, P=0.595), between the ArtiSential® group and the control group.

Conclusions: The new multi-DOF articulating grasper is feasible and can be used as an alternative for prebent graspers during SP-LDG.

Keywords: Articulating device; Gastrectomy; Gastric cancer; Single-port surgery.

Conflict of interest statement

Conflict of Interest: No potential conflict of interest relevant to this article was reported.

Copyright © 2021. Korean Gastric Cancer Association.

Figures

Fig. 1. Comparison of the prebent (Olympus Medical Systems Corp.) instrument to the multi-DOF articulating device.

(A) The shapes of the prebent (Olympus Medical Systems Corp.) instrument (left) and its tip (right). (B) The shapes of the articulating device (left) and its end-effector part (right). DOF = degree-of-freedom.

Fig. 2. Laparoscopic view of the prebent (Olympus Medical Systems Corp.) forceps in performing lymphadenectomy during single-port laparoscopic distal gastrectomy.

(A) Lymphadenectomy in the supra-duodenal area. (B) Lymphadenectomy for lymph node No. 8a. (C) Lymphadenectomy for lymph node No. 7 (LGA). (D) Lymphadenectomy for lymph node No. 1. LGA = left gastric artery.

Fig. 3. Laparoscopic view of the multi-DOF articulating device in lymphadenectomy during single-port laparoscopic distal gastrectomy.

(A) Lymphadenectomy in the supra-duodenal area. (B) Lymphadenectomy in lymph node No. 8a. (C) Lymphadenectomy in lymph node No. 7 (LGA). (D) Lymphadenectomy in lymph node No. 1. The end-effector part of the device is manipulated at various angles and in various shapes to provide a better operative field during lymph node dissection, avoiding intracorporeal collision or crossing of the devices. DOF = degree-of-freedom; LGA = left gastric artery.

Fig. 4. The learning curve for the use of the ArtiSential® (LivsMed) and prebent forceps (Olympus Medical Systems Corp.) in performing lymph node dissection during single-port laparoscopic distal gastrectomy. The time spent for LND was plotted according to the number of cases. The red lines represent the mean LND time before and after the operator's proficiency.

(A) The learning curve for the ArtiSential® (LivsMed) was complete in the 5th case. (B) The LND time using the prebent forceps (Olympus Medical Systems Corp.) demonstrated stability in all cases. LND = lymph node dissection.

Fig. 5. An example of collision between the instruments due to the control part of the ArtiSential® (LivsMed) grasper. The large arch of the control part collided with the ultrasonic energy device (inside the yellow circle).