ArtiSential® Articulated Wrist-Like Instruments and Their First Application in Pediatric Minimally Invasive Surgery: Case Reports and Literature Review of the Most Commonly Available Robot-Inspired Devices

Giovanni Parente, Eduje Thomas, Sara Cravano, Marco Di Mitri, Marzia Vastano, Tommaso Gargano, Tosca Cerasoli, Francesca Ruspi, Michele Libri, Mario Lima, Giovanni Parente, Eduje Thomas, Sara Cravano, Marco Di Mitri, Marzia Vastano, Tommaso Gargano, Tosca Cerasoli, Francesca Ruspi, Michele Libri, Mario Lima

Abstract

Robotic surgery is currently a reality in surgical practice, and many endeavors have been made to extend its application also in pediatric surgery. In the absence of easy access to a robotic surgical system, new devices have been developed to offer a valid alternative such as wristed instruments. These differ from conventional laparoscopic instruments owing to a wrist-like mechanism at the tip, which faithfully reproduces the movements of the surgeon's hands, regaining more movement's degrees; Methods: We present two case reports in which the patients were subjected to minimally invasive procedures with aid of wristed instruments, followed by a review of the literature regarding the devices commonly marketed; Results: Articulated or wristed instruments render the same features seen in robotic surgery, such as major dexterity in smaller spaces, restitution of more natural movements and the ability to get over obstacles in a direct visual line. Our center recently equipped with ArtiSential® articulated instruments and so far, they have proven to be of great value; Conclusions: wristed instruments could represent a standpoint for surgeons wanting to benefit from the advantages of robotic surgery with a cost-sensitive perspective.

Keywords: articulated instruments; laparoscopy; minimally invasive surgery; robot-like instruments; surgical dexterity; thoracoscopy; wrist; wristed instruments.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Thoracoscopic thymectomy performed using ArtiSential® (A): some pictures taken from the surgical procedure in which the enhanced movements’ degrees of freedom even in a small operative space such as a pediatric thorax is clear (B,C). In (D,E) we can see the lymphangioma, resected using the wristed instrument with the aid of indocyanine green highlighting the biliary tree to avoid iatrogenic injury.
Figure 2
Figure 2
(A) Conventional laparoscopic instrument; (B) 5 movement’s degrees of freedom of a conventional laparoscopic instrument; (C) 6th degree of freedom given from a curved instrument. F = fulcrum (fulcrum effect given by trocars).
Figure 3
Figure 3
Most commonly available and updated wrist-like devices. (A) Radius Surgical System® (Tuebingen Scientific), (B) FlexDex® (FlexDex Surgical Inc.), (C) LaproFlex® (DEAM), (D) Intuitool® (UneMed), (E) ArtiSential® (LIVSMED).

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Source: PubMed

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