Utility of articulating instruments as an alternative to robotic devices in laparoscopic right hemicolectomy.

Laparoscopic complete mesocolic excision with central vessel ligation has been widely accepted for its oncological benefits in colon cancer surgery. However, laparoscopic right hemicolectomy involves a risk for vascular injury during dissection around the surgical trunk. This technical difficulty has been attributed to the limited movement of conventional laparoscopic forceps. Although robotic devices can overcome the restricted motion of laparoscopic devices, they are not yet widely used. The ArtiSential is an articulating laparoscopic instrument that has a two-joint end-effector that enables a wide range of motion precisely reflecting the surgeon's finger movements, and is designed to compensate for the drawbacks of conventional laparoscopic tools. The present study demonstrated the utility of articulating instruments in laparoscopic right hemicolectomy by comparing the authors' laparoscopic procedures, using articulating instruments, with robotic procedures. Articulating laparoscopic instruments can be successfully maneuvered in virtually the same manner as robotic devices and, as such, represent a viable alternative to robotic surgery. Supplementary Information: The online version contains supplementary material available at 10.1007/s13691-024-00654-w.

Perioperative outcomes of laparoscopic low anterior resection using ArtiSential® versus robotic approach in patients with rectal cancer: a propensity score matching analysis.

BACKGROUND: Total mesorectal excision using conventional straight fixed devices may be technically difficult because of the narrow and concave pelvis. Several laparoscopic articulating tools have been introduced as an alternative to robotic systems. The aim of this study was to compare perioperative outcomes between laparoscopic low anterior resection using ArtiSential® and robot-assisted surgery for rectal cancer. METHODS: This retrospective study included 682 patients who underwent laparoscopic or robotic low anterior resection  for rectal cancer from September 2018 to December 2021. Among them, 82 underwent laparoscopic surgery using ArtiSential® (group A) and 201 underwent robotic surgery (group B). A total of 73 [group A; 66.37 ± 11.62; group B 65.79 ± 11.34] patients were selected for each group using a propensity score matching analysis. RESULTS: There was no significant difference in the baseline characteristics between group A and B. Mean operative time was longer in group B than A (163.5 ± 61.9 vs 250.1 ± 77.6 min, p < 0.001). Mean length of hospital stay was not significantly different between the two groups (6.2 ± 4.7 vs 6.7 ± 6.1 days, p = 0.617). Postoperative complications, reoperation, and readmission within 30 days after surgery were similar between the two groups. Pathological findings revealed that the circumferential resection margins were above 10 mm in both groups (11.00 ± 7.47 vs 10.17 ± 6.25 mm, p = 0.960). At least 12 lymph nodes were sufficiently harvested, with no significant difference in the number harvested between the groups (20.5 ± 9.9 vs 19.7 ± 7.3, p = 0.753). CONCLUSIONS: Laparoscopic low anterior resection using ArtiSential® can achieve acceptable clinical and oncologic outcomes. ArtiSential®, a multi-joint and articulating device, may serve a feasible alternative approach to robotic surgery in rectal cancer.

Laparoscopic transabdominal preperitoneal herniorrhaphy performed using an articulating laparoscopic instrument is feasible and more efficient.

Introduction: Ipsilateral left-sided-approach laparoscopic transabdominal preperitoneal herniorrhaphy (LA-TAPP) is a procedure used for inguinal hernia. However, conventional laparoscopic instruments may limit the operator's ability to approach certain areas during the procedure. This study aims to assess the feasibility of using an articulating bipolar grasper (ArtiSential®). Material and methods: Between January 2017 and May 2022, 184 patients with inguinal hernia underwent LA-TAPP and were divided into an articulating group (AG) and a conventional group (CG). The two groups were compared for clinical characteristics, surgical outcomes, and recurrence rates. Learning curve analysis was also performed using the CUSUM score. Results: The AG and CG included 72 and 112 patients, respectively. Both groups had similar age, sex, BMI, hernia location, and hernia type. The AG had a significantly shorter operation time (59.2 ± 29.4 vs. 77.8 ± 22.4 min, p < 0.001) than the CG. The duration of hospitalization was slightly shorter in the AG (2.2 ± 0.5 vs. 2.5 ± 1.4 days, p = 0.056). Postoperative complications were lower in the AG (5.6%) than in the CG (9.8%). Scrotal neuralgic pain was observed in 1.4% of patients in the AG and 3.6% of patients in the CG. Learning curve analysis revealed that 24 cases were needed to overcome the learning curve for using an articulating device. Conclusion: IP-TAPP with an articulating instrument is a safe and efficient procedure. The operation time can be reduced by improving the surgeon's procedural autonomy and reducing collisions between the instruments and the patient's ribs.

Initial experience of laparoscopic complete mesocolic excision with D3 lymph node dissection for right colon cancer using Artisential®, a new laparoscopic articulating instrument.

Background: Laparoscopic complete mesocolic excision (CME) with D3 lymph node dissection for the right colon is becoming popular, but still technically challenging. Several articulating laparoscopic instruments had been introduced to reduce technical difficulties; however, those were not practical. This study aimed to report the first clinical experience of using ArtiSential®, a new laparoscopic articulating instrument in laparoscopic complete mesocolic with D3 lymph node dissection for right colon cancer. Patients and Methods: This was a retrospective, single-institution, consecutive case study. From October 2018 to March 2020, a total of 33 patients underwent laparoscopic right hemicolectomy using ArtiSential®, a new articulating instrument. We compared the short-term outcomes of patients who underwent surgery using ArtiSential® (AG) to the conventional instrument (CG). Results: In total, there were 33 cases in AG and 43 cases in CG. There were no significant differences in operation time (141.0 ± 22.5 vs. 156.0 ± 50.6 min, P = 0.09), mean estimated blood loss (46.8 ± 36.2 vs. 100.8 ± 300.6 ml, P = 0.31) and intra-operative and post-operative complications. However, the number of harvested lymph nodes was higher and the length of hospital stay was shorter in AG than in CG (32.6 ± 12.2 vs. 24.6 ± 7.4, P < 0.01 and 3.0 ± 1.2 vs. 4.1 ± 2.2 days, P = 0.01, respectively). Conclusions: Laparoscopic CME with D3 lymph node dissection for right colon cancer using ArtiSential®, the new articulating laparoscopic instrument is safe and technically feasible.

Laparoscopic transverse colectomy using a new articulating instrument.

Laparoscopic complete mesocolic excision is the preferred approach for treating transverse colon cancer. Due to the anatomical complexity, mobilization and resection of the transverse colon can be technically challenging. This video demonstrates laparoscopic transverse colectomy using an articulating laparoscopic instrument for a 76-year-old female patient diagnosed with T-colon cancer.

A Feasibility Study and Technical Tips for the Use of an Articulating Bipolar Vessel Sealer in da Vinci Robot-Assisted Gastrectomy.

BACKGROUND: The aim of this study was to evaluate the efficacy and safety of a new articulating bipolar energy device, the EndoWrist® One™ Vessel Sealer (VS), in da Vinci® robot-assisted gastrectomy. MATERIALS AND METHODS: Patients (n = 17) with cT1/2 gastric cancer who underwent robotic gastrectomy using the VS were prospectively enrolled in the study group (VS group). The clinicopathological outcomes, including operative time, intraoperative blood loss, amount of postoperative drainage, postoperative biochemical analysis results, and complication rates, were prospectively collected and compared with those of patients who underwent robotic gastrectomy using conventional ultrasonic shear force ([US] group, n = 52) during the same time period. RESULTS: Although the VS provided a good direction for dissection because of the articulating function, the ancillary use of conventional bipolar coagulation was occasionally needed due to the blunt, nonactive end tip of the VS. The operative time, intraoperative blood loss, postoperative drainage, and absence of complication rates did not differ between the VS and US groups, but the C-reactive protein levels on the second postoperative day (8.06 versus 11.7, P = .002) and serum albumin levels on the fifth postoperative day (3.51 versus 3.32, P = .019) were superior in the VS group. CONCLUSION: Use of the VS in robotic gastrectomy was feasible and provided good configuration in the direction of dissection. The learning process for use of the VS in the initial series was relatively rapid, resulting in comparable results between the VS and US groups. Reduced inflammation and albumin loss were identified as possible benefits of the VS.