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Gibson EA. Augmenting Veterinary Minimally Invasive Surgery: Evidence-based Review of Foundational and Novel Devices and Technology. Vet Clin North Am Small Anim Pract 2024; 54:721-733. [PMID: 38519369 DOI: 10.1016/j.cvsm.2024.02.007] [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: 03/24/2024]
Abstract
Veterinary minimally invasive surgery continues to grow as a specialty. With increasing experience in this field, comes improved accessibility as well as progressive complexity of procedures performed. Advancement in technology has been both a response to the growth and a necessary driver of continued refinement of this field. Innovative research leading to advancements in surgical equipment has led to the development of novel image acquisition platforms, cannulas, smoke evacuation systems, antifog devices, instrumentation, and ligating/hemostatic devices. These innovations will be reviewed and potential clinical applications are discussed.
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Affiliation(s)
- Erin A Gibson
- University of Pennsylvania, Matthew J. Ryan Veterinary Hospital, Department of Clinical Sciences and Advanced Medicine, 3900 Delancey Street, Philadelphia, PA 19104, USA.
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2
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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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3
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Voskens FJ, van der Schans EM, Ruurda JP, Broeders IAMJ. Endoscopic surgery suturing techniques: a randomized study on learning. BMC Surg 2022; 22:59. [PMID: 35172810 PMCID: PMC8851769 DOI: 10.1186/s12893-022-01513-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 02/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surgeons have widely adopted endoscopic suturing techniques using conventional laparoscopic instruments and the more advanced robotic systems. The FlexDex is a novel articulating laparoscopic needle driver providing enhanced dexterity in laparoscopic surgery. This study evaluates and compares the learning curve of endoscopic suturing with conventional laparoscopy, the FlexDex and robotic suturing in novices. METHODS Participants performed a minimal invasive suturing task in three different ways in a randomized order: with a conventional laparoscopic needle driver, using the FlexDex needle driver and third, using the Da Vinci Si surgical system. Primary outcome was suturing task time. Secondary outcome parameters were assessment of suturing quality and workload perception. RESULTS A total of 10 novice participants were included and completed a total of 300 sessions. Median (IQR) suturing time of the first 5 sessions was 231 s (188-291) in the laparoscopic group versus 378 s (282-471) in the FlexDex group versus 189 s (160-247) in the DaVinci Si group. The last 5 sessions showed significant reduction of median suturing time of 143 s (120-190), 232 s (180-265) and 172 s (134-199) respectively. Analysis identified that the learning curve for the laparoscopic needle driver and Da Vinci Si was reached in 5 sessions, compared to 8 sessions for the Flexdex. The laparoscopic needle driver and Da Vinci Si showed a significant shorter median suturing time compared to the FlexDex (p = 0.00). The FlexDex quality assessment scores were significantly lower compared to the laparoscopic (p = 0.00) and robotic (p = 0.00) scores and perceived workload remains high for the FlexDex users. CONCLUSIONS Ex vivo endoscopic suturing with the FlexDex demonstrated a prolonged learning curve compared to laparoscopic and robotic suturing. The learning curve of the FlexDex is fundamentally different from conventional laparoscopic and robotic instruments. This study provides further insights in the implementation and training of endoscopic suturing techniques.
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Affiliation(s)
- F J Voskens
- Department of Surgery, Meander Medical Center, Maatweg 3, Amersfoort, The Netherlands. .,University of Twente, Robotics and Mechatronics, Enschede, The Netherlands.
| | - E M van der Schans
- Department of Surgery, Meander Medical Center, Maatweg 3, Amersfoort, The Netherlands.,University of Twente, Robotics and Mechatronics, Enschede, The Netherlands
| | - J P Ruurda
- Department of Gastro-Intestinal and Oncologic Surgery, University Medical Center, Utrecht, The Netherlands
| | - I A M J Broeders
- Department of Surgery, Meander Medical Center, Maatweg 3, Amersfoort, The Netherlands.,University of Twente, Robotics and Mechatronics, Enschede, The Netherlands
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Motahariasl N, Farzaneh SB, Motahariasl S, Kokotkin I, Sousi S, Zargaran A, Zargaran D, Patel B. Assessment of an Articulating Laparoscopic Needle Holder (FlexDex™) Compared to a Conventional Rigid Needle Holder in 2-Dimension Vision Amongst Novices: A Randomised Controlled Study. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2022; 15:15-25. [PMID: 35153517 PMCID: PMC8824294 DOI: 10.2147/mder.s345140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/12/2022] [Indexed: 11/23/2022] Open
Abstract
Aim This study aims to compare novice performance of advanced bimanual laparoscopic skills using an articulating laparoscopic device (FlexDex™) compared to a standard rigid needle holder amongst surgical novices in 2-dimension (2D) visualisation. Methods In this prospective randomised trial, novices (n = 40) without laparoscopic experience were recruited and randomised into two groups, which used either traditional rigid needle holders or the FlexDex™. Both groups performed 10 repetitions of a validated assessment task. Times taken and error rates were recorded, and results were evaluated based on completion times, error rates, and learning curves. Results The intervention group that used the FlexDex™ completed 10 attempts of the standardised laparoscopic task slower than the control group that used traditional rigid needle holder (415 s versus 267 s taken for the first three attempts and 283 s versus 187 s taken for the last three attempts, respectively). The difference in average time for the first three and last three attempts reached statistical significance (P < 0.001). Furthermore, the intervention group demonstrated a higher error rate when compared to the control group (9.3 versus 6.2 errors per individual). Conclusion When compared to the FlexDex™, the traditional rigid needle holder was observed to be superior in task performance speed, leading to shorter completion times and quicker learning effect, as well as fewer errors. Key Statement Traditional rigid needle holder leads to faster task completion times and lower error rates when compared with an articulating laparoscopic needle holder in 2D vision.
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Affiliation(s)
| | | | | | - Ilya Kokotkin
- St George’s University of London, London, SW17 0RE, UK
| | - Sara Sousi
- Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, W12 0NN, UK
- King’s College London, London, SE1 1UL, Greater London, UK
- Correspondence: Sara Sousi, Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, W12 0NN, UK, Email
| | - Alexander Zargaran
- King’s College London, London, SE1 1UL, Greater London, UK
- Chelsea and Westminster Hospital, London, SW10 9NH, UK
| | | | - Bijendra Patel
- Barts Cancer Institute, Queen Mary University of London, London, UK
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Hernández-Valderrama VG, Ordorica-Flores RM, Montoya-Alvarez S, Haro-Mendoza D, Ochoa-Toledo L, Lorias-Espinoza D, Ortiz-Simón JL, Pérez-Escamirosa F. Steerable Surgical Instrument for Conventional and Single-Site Minimally Invasive Surgery. Surg Innov 2021; 29:449-458. [PMID: 34358428 DOI: 10.1177/15533506211037091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. This article aims to present an innovative design of a steerable surgical instrument for conventional and single-site minimally invasive surgery (MIS), which improves the dexterity and maneuverability of the surgeon while offering a solution to the limitations of current tools. Methods. The steerable MIS instrument consists of a deflection structure with a curved sliding joints design that articulates the distal tip in two additional degrees of freedom (DoFs), relative to the instrument shaft, using transmission by cables. A passive ball-joint mechanism articulates the handle relative to the instrument shaft, improves wrist posture, and prevents collision of instrument handles during single-site MIS procedures. The two additional DoFs of the articulating tip are activated by a thumb-controlled device, using a joystick design mounted on the handle. This steerable MIS instrument was developed by additive manufacturing in a 3D printer using PLA polymer. Results. Prototype testing showed a maximum tip deflection of 60° in the left and right directions, with a total deflection of 120°. With the passive ball-joint fully offset, the steerable tip achieved a deflection of 90° for the right and 40° for the left direction, with a total deflection of 130°. Furthermore, the passive ball-joint mechanism in the handle obtained a maximum range of motion of 60°. Conclusions. This steerable MIS instrument concept offers an alternative to enhance the application fields of conventional and single-site MIS, increasing manual dexterity of the surgeon and the ability to reach narrow anatomies from other directions.
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Affiliation(s)
- Victor Gabriel Hernández-Valderrama
- Instituto de Ciencias Aplicadas y Tecnología (ICAT), 7180Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México.,Posgrado de Ingeniería Mecánica, Centro de Ingeniería Avanzada, Departamento de Mecatrónica, Facultad de Ingeniería, 7180Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México
| | | | - Salvador Montoya-Alvarez
- Sección de Bioelectrónica, Departamento de Ingeniería Eléctrica, 42576Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Ciudad de México, México
| | - Daniel Haro-Mendoza
- Posgrado de Ingeniería Mecánica, Centro de Ingeniería Avanzada, Departamento de Mecatrónica, Facultad de Ingeniería, 7180Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México
| | - Luis Ochoa-Toledo
- Instituto de Ciencias Aplicadas y Tecnología (ICAT), 7180Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México
| | - Daniel Lorias-Espinoza
- Sección de Bioelectrónica, Departamento de Ingeniería Eléctrica, 42576Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional (CINVESTAV-IPN), Ciudad de México, México
| | - José L Ortiz-Simón
- Tecnológico Nacional de México, 183400Instituto Tecnológico de Nuevo Laredo, Nuevo Laredo, Tamaulipas
| | - Fernando Pérez-Escamirosa
- Instituto de Ciencias Aplicadas y Tecnología (ICAT), 7180Universidad Nacional Autónoma de México (UNAM), Ciudad de México, México
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Advances and Trends in Pediatric Minimally Invasive Surgery. J Clin Med 2020; 9:jcm9123999. [PMID: 33321836 PMCID: PMC7764454 DOI: 10.3390/jcm9123999] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 11/28/2020] [Accepted: 12/03/2020] [Indexed: 12/11/2022] Open
Abstract
As many meta-analyses comparing pediatric minimally invasive to open surgery can be found in the literature, the aim of this review is to summarize the current state of minimally invasive pediatric surgery and specifically focus on the trends and developments which we expect in the upcoming years. Print and electronic databases were systematically searched for specific keywords, and cross-link searches with references found in the literature were added. Full-text articles were obtained, and eligibility criteria were applied independently. Pediatric minimally invasive surgery is a wide field, ranging from minimally invasive fetal surgery over microlaparoscopy in newborns to robotic surgery in adolescents. New techniques and devices, like natural orifice transluminal endoscopic surgery (NOTES), single-incision and endoscopic surgery, as well as the artificial uterus as a backup for surgery in preterm fetuses, all contribute to the development of less invasive procedures for children. In spite of all promising technical developments which will definitely change the way pediatric surgeons will perform minimally invasive procedures in the upcoming years, one must bear in mind that only hard data of prospective randomized controlled and double-blind trials can validate whether these techniques and devices really improve the surgical outcome of our patients.
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7
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Robotic-like suturing with FlexDex Surgical System® for difficult laparoscopic suture. Cir Esp 2020; 99:222-228. [PMID: 33198944 DOI: 10.1016/j.ciresp.2020.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/02/2020] [Accepted: 10/12/2020] [Indexed: 02/06/2023]
Abstract
The field of laparoscopic surgery has experienced an exponential growth in recent years. Despite great progress in this field, standard laparoscopic tools have not been optimally developed and still has some deficiencies when it comes to mobility and ergonomics. Robotic surgery has attempted to solve these problems by improving the articulation of surgical instruments. However, it presents a series of disadvantages, among which are its high cost, low availability and the need of a specific training, which conditions its profitability and hinders a widespread use. We present the results of a prospective clinical series of 20 cases in which the safety, efficacy and ergonomics of FlexDex® have been tested for performing laparoscopic intracorporeal sutures. The result is a safe and functional tool that offers both control and precision in its handling, while improves the ergonomics of the surgeon. This device represents an alternative that combines the precision and range of movements of robotic surgery with the greater availability of conventional laparoscopy.
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8
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Luo Y, Wang P, Gu X, Ye J, Lin J, Tan M, Luo PT, Luo JT, Huang M. Placement of pelvic mesh prior to pelvic radiotherapy using FlexDex™ - a video vignette. Colorectal Dis 2020; 22:1458-1459. [PMID: 32336011 PMCID: PMC7818471 DOI: 10.1111/codi.15083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 04/02/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Y. Luo
- Department of Colorectal SurgeryGuangdong Institute of GastroenterologyGuangdong Provincial Key Laboratory of Colorectal and Pelvic Floor DiseaseSupported by National Key Clinical DisciplineThe Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - P. Wang
- Department of Colorectal SurgeryGuangdong Institute of GastroenterologyGuangdong Provincial Key Laboratory of Colorectal and Pelvic Floor DiseaseSupported by National Key Clinical DisciplineThe Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - X. Gu
- Department of SurgeryThe People’s Hospital of Gaoming DistrictFoshanChina
| | - J. Ye
- Department of Colorectal SurgeryGuangdong Institute of GastroenterologyGuangdong Provincial Key Laboratory of Colorectal and Pelvic Floor DiseaseSupported by National Key Clinical DisciplineThe Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - J. Lin
- Department of Colorectal SurgeryGuangdong Institute of GastroenterologyGuangdong Provincial Key Laboratory of Colorectal and Pelvic Floor DiseaseSupported by National Key Clinical DisciplineThe Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - M. Tan
- SEOX Financial Quotient (Guangzhou) Education Technology LtdGuangzhouChina
| | - P. T. Luo
- Class 9 Grade 3The Affiliated Foreign Language School of SCNUGuangzhouChina
| | - J. T. Luo
- Class 6 Grade 1The Affiliated Foreign Language School of SCNUGuangzhouChina
| | - M. Huang
- Department of Colorectal SurgeryGuangdong Institute of GastroenterologyGuangdong Provincial Key Laboratory of Colorectal and Pelvic Floor DiseaseSupported by National Key Clinical DisciplineThe Sixth Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
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Pantalos G, Patsouras D, Spartalis E, Dimitroulis D, Tsourouflis G, Nikiteas N. Three-dimensional Versus Two-dimensional Laparoscopic Surgery for Colorectal Cancer: Systematic Review and Meta-analysis. In Vivo 2020; 34:11-21. [PMID: 31882458 DOI: 10.21873/invivo.11740] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/11/2019] [Accepted: 10/21/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND/AIM Three-dimensional (3D) laparoscopy is being steadily adopted instead of two-dimensional (2D) for various procedures. Our aim was to compare the outcomes between 2D and 3D laparoscopic procedures for colorectal cancer in order to ascertain the safety, efficacy and potential advantages of 3D imaging systems. MATERIALS AND METHODS A systematic database search was conducted in March 2019. Comparative studies reporting clinical outcomes between patients undergoing elective colorectal procedures using either 2D or 3D laparoscopic equipment were eligible. RESULTS Six studies were selected, including 614 patients in total. Minor reduction in operative time, similar blood loss and increased number of harvested lymph nodes was noted for the 3D group. There was no difference for conversion to open surgery, time to flatus, postoperative hospital stay or postoperative complications. CONCLUSION 3D Laparoscopic surgery for colorectal cancer may result in reduction of operative time and higher lymph node yields, leading to improved survival.
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Affiliation(s)
- George Pantalos
- Second Department of Pediatric Surgery, P. & A. Kyriakou Hospital, Athens, Greece .,Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens, Greece.,Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece
| | - Dimitrios Patsouras
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens, Greece.,Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece
| | - Eleftherios Spartalis
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens, Greece.,Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece
| | - Dimitrios Dimitroulis
- Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece.,Second Department of Propaedeutic Surgery, Laiko General Hospital, University of Athens Medical School, Athens, Greece
| | - Gerasimos Tsourouflis
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens, Greece.,Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece.,Second Department of Propaedeutic Surgery, Laiko General Hospital, University of Athens Medical School, Athens, Greece
| | - Nikolaos Nikiteas
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens, Greece.,Hellenic Minimally Invasive and Robotic Surgery (MIRS) Study Group, Athens, Greece.,Second Department of Propaedeutic Surgery, Laiko General Hospital, University of Athens Medical School, Athens, Greece
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