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Mao R, Gao L, Gang W, Wen L. Literature Review of Handheld Articulating Instruments in Minimally Invasive Surgery. J Laparoendosc Adv Surg Tech A 2024; 34:47-54. [PMID: 37870762 DOI: 10.1089/lap.2023.0366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Abstract
Background: Minimally invasive surgery (MIS) using handheld articulating instruments (HAIs) has emerged as an innovative approach, offering enhanced dexterity and accessibility compared with conventional straight tools. There has been a significant surge in market interest surrounding HAIs. However, the question about the potential benefits of these devices for surgeons and patients in clinical applications remains unclear. Methods: We thoroughly searched relevant literature about the HAIs with clinical applications. This article reviews the feasibility, safety, outcomes, ergonomics, and learning curve associated with utilizing HAIs, including notable commercial products FlexDex, ArtiSential, and HandX. This study also investigates the comparisons of the use of HAIs with traditional laparoscopy and the da Vinci robotic system in terms of surgical outcomes and operational efficiency. Results: Early clinical studies demonstrate the applicability of HAIs across gastrointestinal, urologic, cardiothoracic, and general surgery, with promising results and few complications reported. Comparisons with conventional laparoscopy reveal no significant differences in surgical outcomes. However, HAIs present a more prolonged learning curve than robotic surgery for novice users. Combining three-dimensional visualization techniques facilitate performance. Further research with larger sample sizes is warranted to establish definitive superiority in surgical efficiency and characterize optimal training methodology. Conclusions: Overall, the maneuverability and lower cost of HAIs present new possibilities in MIS, potentially expanding accessibility for smaller health care organizations and benefiting more patients.
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Affiliation(s)
- Rui Mao
- Department of Medical Equipment, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Lei Gao
- Department of Medical Equipment, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Wu Gang
- Hepatobiliary and Pancreatic Surgery Department, Sichuan Provincial People's Hospital, Chengdu, China
| | - Lin Wen
- Department of Medical Equipment, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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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. CHILDREN-BASEL 2021; 8:children8070603. [PMID: 34356582 PMCID: PMC8306555 DOI: 10.3390/children8070603] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/10/2021] [Accepted: 07/16/2021] [Indexed: 11/21/2022]
Abstract
Background: 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.
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Lacitignola L, Trisciuzzi R, Imperante A, Fracassi L, Crovace AM, Staffieri F. Comparison of Laparoscopic Steerable Instruments Performed by Expert Surgeons and Novices. Vet Sci 2020; 7:vetsci7030135. [PMID: 32942765 PMCID: PMC7558073 DOI: 10.3390/vetsci7030135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/14/2020] [Accepted: 09/14/2020] [Indexed: 01/19/2023] Open
Abstract
As an alternative to the surgical robot, some medical companies have engineered new steerable devices that mimic the robot’s capacities. This study aimed to assess how steerable instruments ameliorate the efficacy of suturing in comparison with the traditional instrument, and a combination instruments, performed by experienced and novice surgeons. The study was performed by three experienced surgeons and three novice surgeons. The instruments employed were divided into three surgical sets: two steerable dissectors; one steerable dissector and one straight needle; two straight needle holders. The study supervisor recorded the total time for the procedure, the number of bites completed, the time for each bite, and the quality of the procedure. In our study, we found consistent data demonstrating that experienced laparoscopists completed the prescribed suture pattern with more bites in less time than novices. The use of two steerable instruments was more time consuming than standard straight instruments, but a combination of instruments was significantly less time consuming, as was the use of two straight needle holders. This result was even observed in novice surgeons. Combining a steerable instrument with a traditional straight needle holder provided more advantages in this study.
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Affiliation(s)
- Luca Lacitignola
- Dipartimento dell’Emergenza e dei Trapianti di Organi (DETO), Sezione di Cliniche Veterinarie e P.A, Università degli Studi di Bari “Aldo Moro”, 70010 Bari, Italy; (L.F.); (F.S.)
- Correspondence: ; Tel.: +39-08-0467-9872
| | - Rodrigo Trisciuzzi
- Dottorato di Ricerca in “Trapianti di Tessuti ed Organi e Terapie Cellulari”, Dipartimento dell’Emergenza e dei Trapianti di Organi (DETO), Università degli Studi di Bari “Aldo Moro”, 70100 Bari, Italy; (R.T.); (A.I.)
| | - Annarita Imperante
- Dottorato di Ricerca in “Trapianti di Tessuti ed Organi e Terapie Cellulari”, Dipartimento dell’Emergenza e dei Trapianti di Organi (DETO), Università degli Studi di Bari “Aldo Moro”, 70100 Bari, Italy; (R.T.); (A.I.)
| | - Laura Fracassi
- Dipartimento dell’Emergenza e dei Trapianti di Organi (DETO), Sezione di Cliniche Veterinarie e P.A, Università degli Studi di Bari “Aldo Moro”, 70010 Bari, Italy; (L.F.); (F.S.)
| | - Alberto Maria Crovace
- Scuola di Bioscienze e Medicina Veterinaria, Università di Camerino, 62024 Matelica, Italy;
| | - Francesco Staffieri
- Dipartimento dell’Emergenza e dei Trapianti di Organi (DETO), Sezione di Cliniche Veterinarie e P.A, Università degli Studi di Bari “Aldo Moro”, 70010 Bari, Italy; (L.F.); (F.S.)
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Anderson PL, Lathrop RA, Webster RJ. Robot-like dexterity without computers and motors: a review of hand-held laparoscopic instruments with wrist-like tip articulation. Expert Rev Med Devices 2016; 13:661-72. [PMID: 26808896 PMCID: PMC5927586 DOI: 10.1586/17434440.2016.1146585] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 01/22/2016] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Conventional manual laparoscopic instruments for minimally invasive surgery have limited dexterity within the patient, making procedures challenging. Surgical robotic systems offer enhanced articulation, but at substantial financial costs. This has motivated the development of high-dexterity, low-cost laparoscopic instruments. AREAS COVERED This article reviews both commercial and academic results on creating fully mechanical (i.e. non-robotic) laparoscopic instruments that provide wrists or wrist-like dexterity within the patient. We review the state of the art in the development of these mechanical instruments, focusing on the surgeon interface, wrist mechanism, and the kinematic mapping between the two. Expert commentary: Current articulated mechanical laparoscopic instruments exhibit a wide range of designs, with no clear consensus on what makes such devices easy to use. As these technologies mature, user studies are needed to determine surgeon preferences. Articulated, low-cost instruments have the potential to impact the minimally invasive surgery market if they provide compelling benefits to surgeons.
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Affiliation(s)
| | - Ray A Lathrop
- a Mechanical Engineering , Vanderbilt University , Nashville , USA
| | - Robert J Webster
- a Mechanical Engineering , Vanderbilt University , Nashville , USA
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Takazawa S, Ishimaru T, Fujii M, Harada K, Deie K, Fujishiro J, Sugita N, Mitsuishi M, Iwanaka T. A multi-degree-of-freedom needle driver with a short tip and small shaft for pediatric laparoscopic surgery: in vivo assessment of multi-directional suturing on the vertical plane of the liver in rabbits. Surg Endosc 2015; 30:3646-53. [PMID: 26511118 DOI: 10.1007/s00464-015-4616-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 10/05/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Laparoscopic Kasai portoenterostomy has been performed in infants with biliary atresia at several institutions, but laparoscopic anastomosis requiring multi-directional suturing on a vertical plane of the liver remains a challenge. To assist multi-directional suturing, we developed a multi-degree-of-freedom (DOF) needle driver whose tip length was 15 mm and shaft diameter was 3.5 mm. The tip of the multi-DOF needle driver has three DOFs for grasp, flection and rotation. The aim of this study was to evaluate the performance of the multi-DOF needle driver in two kinds of in vivo experiments. METHODS Surgeons were asked to perform four-directional laparoscopic suturing on a vertical plane of the liver in six rabbits using the multi-DOF needle driver or a conventional needle driver. The needle grasping time, the needle handling time, the number of needle insertions, the number of liver lacerations, the suturing width and depth, and the area of necrotic tissues were analyzed and compared. Additionally, one surgeon was asked to perform laparoscopic hepato-jejunostomy in four rabbits to assess the feasibility of Kasai portoenterostomy using the multi-DOF needle driver. RESULTS The suturing depth using the multi-DOF needle driver was significantly larger than that using the conventional needle driver in both the right and downward suturing directions. No statistically significant differences were found in other metrics. Liver lacerations were observed only when suturing was performed using the conventional needle driver. The experimental laparoscopic hepato-jejunostomy using the multi-DOF needle driver was successful. CONCLUSIONS Using the multi-DOF needle driver, uniform multi-directional suturing on a vertical plane of the liver could be performed. The short distal tip of the multi-DOF needle driver demonstrated its advantages in multi-directional suturing in a small body cavity. The multi-DOF needle driver may be able to be used to perform complex tasks in laparoscopic Kasai portoenterostomy.
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Affiliation(s)
- Shinya Takazawa
- Department of Pediatric Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tetsuya Ishimaru
- Department of Pediatric Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Masahiro Fujii
- Department of Mechanical Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan
| | - Kanako Harada
- Department of Mechanical Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan
| | - Kyoichi Deie
- Department of Pediatric Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Jun Fujishiro
- Department of Pediatric Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Naohiko Sugita
- Department of Mechanical Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan
| | - Mamoru Mitsuishi
- Department of Mechanical Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan
| | - Tadashi Iwanaka
- Department of Pediatric Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Saitama Children's Medical Center, 2100 Magome, Iwatsuki-ku, Saitama, Saitama, 339-8551, Japan
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