Evaluation of new motorized articulating laparoscopic instruments by laparoscopic novices using a standardized laparoscopic skills curriculum

Abstract

Background Motorized articulating laparoscopic instruments (ALI) offer more degrees of freedom than conventional laparoscopic instruments (CLI). However, a difficult learning curve and complex instrument handling are still a problem of ALI. We compared the performance of new prototypes of motorized ALI with CLI in a series of standardized laparoscopic tasks performed by laparoscopic novices. Further, usability of the new ALI was assessed. Methods A randomized cross-over study with 50 laparoscopic novices who either started with CLI and then changed to ALI (CA) or vice versa (AC) was conducted. All participants performed the European training in basic laparoscopic urological skills (E-BLUS) with each instrument in given order. Time and errors were measured for each exercise. Instrument usability was assessed. Results Overall, using CLI was significantly faster (CLI 4:27 min vs. ALI 4:50 min; p-value 0.005) and associated with fewer exercise failures in needle guidance (CLI 0 vs. ALI 12; p-value 0.0005) than ALI. Median amount of errors was similar for both instruments. Instrument sequence did not matter, as CA and AC showed comparable completion times. Regarding the learning effect, participants were significantly faster in the second attempt of exercises than in the first. In the needle guidance task, participants using CLI last demonstrated a significant speed improvement, whereas ALI were significantly slower in the second run. Regarding usability, CLI were preferred over ALI due to lighter weight and easier handling. Nevertheless, participants valued ALI’s additional degrees of freedom. Conclusion Using new motorized ALI in the E-BLUS examination by laparoscopic novices led to a worse performance compared to CLI. An explanation could be that participants felt overwhelmed by ALI and that ALI have an own distinct learning curve. As participants valued ALI’s additional degrees of freedom, however, a future application of ALI could be for training purposes, ideally in combination with CLI.

Safe implementation of hand held steerable laparoscopic instruments: a survey among EAES surgeons

“…Previous studies have compared conventional and steerable laparoscopic instruments in performance, ergonomics, learning curve and (the lack of) training [ 15 , 18 , 27 , 28 ]. Santos et al [ 28 ] compared two groups of medical students ( n = 45) with one group receiving laparoscopic training with conventional instruments, and the other group receiving single-incision laparoscopy training with articulating instruments.…”

“…The learning curve for the articulating instruments was longer compared to conventional instruments and the performance with conventional instruments was superior. Besides, Uysal et al (2020) [27] performed a randomized cross-over study with fifty laparoscopic novices comparing conventional and articulating laparoscopic instruments in completing the European training in basic laparoscopic urological skills (E-BLUS). The conventional laparoscopic instruments group had a better performance, with the longer learning curve of the articulating instruments being one of the possible reasons for this outcome.…”

“…However, the complexity of the SLI may result in a more shallow learning curve and, therefore, may require additional training to pursue mastery of skills. The angular amplification of the instrument tip and the more complex handle controls due to the increased degrees of freedom could overwhelm the surgeon and cause an initial longer training process [ 21 , 27 ].…”

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

“…A study by Uysal et al comparing the learning curve between articulating and conventional laparoscopic instruments amongst surgical novices also found similar results in favour of conventional instruments. 16 The longer learning curve could be attributed to factors such as the complexity of generating the desired movement with the FlexDex™, Its un-ergonomic hand placement when operating the device and finally difficulties in releasing the device from one’s hand.…”

Advances and Trends in Pediatric Minimally Invasive Surgery

“…Several other articulating instruments as well as prototypes have been described and examined during the last ten years of development, which was mainly driven by the push of Intuitive's DaVinci endowrist and robotic surgery [103,104,[113][114][115][116][117][118].…”