Paediatric computer-assisted retroperitoneoscopic nephrectomy compared with open surgery

Anderberg, Magnus; Kockum, Christina Clementson; Arnbjörnsson, Einar

doi:10.1007/s00383-011-2860-1

Cited by 7 publications

(1 citation statement)

References 21 publications

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“…These differences in articulating segment length mean that the ‘gooseneck’ 5‐mm instruments need more room to manoeuvre and are paradoxically less well suited to smaller operating workspaces. This explains the unfavourable subjective impressions that these instruments gave in the present study and the reasons for critical opinion in the clinical literature . The longer curve radius of the 5‐mm robotic instrument continuum wrist design undoubtedly accounts for the higher workspace boundary breach counts that were observed compared with 8‐mm robotic instruments that possess a compact proprietary EndoWrist ® (Intuitive Surgical; Fig.…”

Section: Discussionmentioning

confidence: 78%

Robotic versus non‐robotic instruments in spatially constrained operating workspaces: a pre‐clinical randomized crossover study

et al. 2015

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ObjectiveTo compare the effectiveness of robotic and non-robotic laparoscopic instruments in spatially constrained workspaces. Materials and MethodsSurgeons performed intracorporeal sutures with various instruments within three different cylindrical workspace sizes. Three pairs of instruments were compared: 3-mm non-robotic mini-laparoscopy instruments; 5-mm robotic instruments; and 8-mm robotic instruments. Workspace diameters were 4, 6 and 8 cm, with volumes of 50, 113 and 201 cm 3 respectively. Primary outcomes were validated objective task performance scores and instrument workspace breach counts. ResultsA total of 23 participants performed 276 suture task repetitions. The overall median task performance scores for the 3-, 5-and 8-mm instruments were 421, 398 and 402, respectively (P = 0.12). Task scores were highest (best) for the 3-mm non-robotic instruments in all workspace sizes. Scores were significantly lower when spatial constraints were imposed, with median task scores for the 4-, 6-and 8-cm diameter workspaces being 388, 415 and 420, respectively (P = 0.026). Significant indirect relationships were seen between boundary breaches and workspace size (P < 0.001). Higher breach counts occurred with the robotic instruments. ConclusionsSmaller workspaces limit the performance of both robotic and non-robotic instruments. In operating workspaces <200 cm 3 , 3-mm non-robotic instruments are better suited for advanced bimanual operative tasks such as suturing. Future robotic instruments need further optimization if this technology is to be uniquely advantageous for clinical roles that involve endoscopic access to workspace-restricted anatomical areas.

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Section: Discussionmentioning

confidence: 78%