Deflectable endoscopic instrument system DENIS.

ABSTRACT

BACKGROUND: The degrees of intraoperative movement with rigid standard instruments during laparo-endoscopic surgery are limited to translation, rotation, and pivoting within the insertion point. Additional distal angulation and rotation of the instrument jaws are a potential improvement. METHODS: Different types of articulated instruments have been developed and tested in phantom and animal experiments. The final prototype was used on 30 patients during laparoscopic surgery following a standardized test protocol. RESULTS: The final design incorporates elastically linked tubular segments, 0-120 degrees variable curvature, and +/- 360 degrees rotation of the jaws element. All functions can be operated with one hand. Testing on phantom and in laparoscopic surgery showed improved handling of organs and tissue with no complications. CONCLUSION: We were able to demonstrate the feasibility of the technical design and the clinical applicability of a deflectable endoscopic instrument system. Although our initial results indicate an improvement in laparoscopic tissue manipulation, the current deflection and jaw rotation require further technical refinement.