Effect of three training programs on surgical performance in single-port laparoscopic surgery.

OBJECTIVE: The aim of this study was to evaluate the effect of three training methodologies on the acquisition of psychomotor skills for laparoendoscopic single-site surgery (LESS), using straight and articulating instruments. METHODS: A prospective study was conducted with subjects randomly divided into three groups, who performed a specific training for 12 days using three laparoscopic tasks in a laparoscopic simulator. Group-A trained in conventional laparoscopy setting using straight instruments and in LESS setting using both straight and articulating instruments. Group-B trained in LESS setting using straight and articulating instruments, whereas Group-C trained in LESS setting using articulating instruments. Participants' performance was recorded with a video-tracking system and evaluated with 12 motion analysis parameters (MAPs). RESULTS: All groups obtained significant differences in their performance in most of the MAPs. Group-C showed an improvement in nine MAPs, with a high level of technical competence. Group-A presented a marked improvement in bimanual dexterity skills. CONCLUSIONS: Training in LESS surgery using articulating laparoscopic instruments improves the quality of skills and allows smoother learning curves.

OBJETIVO: Evaluar el efecto de tres métodos de entrenamiento en la adquisición de habilidades psicomotrices para la cirugía laparoendoscópica por puerto único (LESS, laparoendoscopic single-site surgery) utilizando instrumental recto y articulado. MÉTODO: Se realizó un estudio prospectivo con sujetos divididos aleatoriamente en tres grupos, quienes realizaron un entrenamiento específico durante 12 días utilizando tres tareas laparoscópicas en un simulador laparoscópico. El grupo A entrenó en el entorno laparoscópico convencional con instrumentos rectos, y en el entorno LESS con instrumentos rectos y articulados. El grupo B entrenó en el entorno LESS con instrumentos rectos y articulados. El Grupo C entrenó en el entorno LESS con instrumentos articulados. El desempeño de los participantes se registró con un sistema de seguimiento en video y fue evaluado con 12 parámetros de análisis de movimiento (MAP, motion analysis parameters). RESULTADOS: Todos los grupos obtuvieron diferencias significativas en su desempeño para la mayoría de los MAP. El grupo C mostró una mejora en nueve MAP, con un alto nivel de competencia técnica. El grupo A mostró una marcada mejora en la habilidad de destreza bimanual. CONCLUSIONES: El entrenamiento en cirugía LESS con instrumentos articulados mejora la calidad de las habilidades adquiridas y permite curvas de aprendizaje más suaves.

Literature Review of Handheld Articulating Instruments in Minimally Invasive Surgery.

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.

A rare case of a retrocrural lymph node metastasis from a chromophobe renal cell cancer: complete thoracoscopic resection with a new multi-joint articulating surgical instrument.

We report a rare case of a 69-year-old man with a solitary retrocrural lymph node metastasis in the posterior mediastinum of an oligo-metastatic chromophobe renal cell cancer that was radically resected in a curative intent using new articulating Artisential® instruments.

Mechanical evaluation of articulating instruments and cross-handed manipulation in laparoendoscopic single-site surgery.

BACKGROUND: Laparoendoscopic single-site surgery (LESS) is limited by loss of triangulation and internal instruments conflict. To overcome these difficulties, some concepts have been introduced, namely, articulating instruments and cross-handed manipulation, which causes the right hand to control the left instrument tip and vice versa. The aim of this study was to compare task performance with different approaches based on a mechanical evaluation platform. METHODS: A LESS mechanical evaluation platform was set up to investigate the performance of 2 tasks (suture pass-through rings and clip-cut) with 3 different settings: uncrossed manipulation with straight instruments (group A, the control group), uncrossed manipulation with articulating instruments (group B), and cross-handed manipulation with articulating instruments (group C). The operation time and average load required for accomplishment of the standard tasks were measured. RESULTS: Group A presented significantly better time scores than group B, and group C consumed the longest time to accomplish the 2 tasks (P < .05). Comparing of average load required to perform the suture pass-through rings task, it differed significantly between dominant and nondominant hand in all groups (P < .01) and was less in group A and group B than group C in dominant hand (P < .01), while it was almost the same in all groups in the nondominant hand. In terms of average load requirement to accomplish clip-cut task, it was almost equal not only between group A and B but also between dominant and nondominant hand while the increase reached statistical significance when comparing group C with other groups (P < .05). CONCLUSIONS: Compared with conventional devices and maneuvering techniques, articulating instruments and cross-handed manipulation are associated with longer operation time and higher workload. Instruments with better maneuverability should be developed in the future for LESS.