The trade-off between flexibility and maneuverability: task performance with articulating laparoscopic instruments

Abstract

Experienced surgeons are readily able to transfer their skills from conventional to articulating laparoscopic instruments. To speed the learning process, the use of articulating instruments can be started at an early stage of surgical training.

Effect of training and instrument type on performance in single-incision laparoscopy: Results of a randomized comparison using a surgical simulator

“…The addition of dynamic control to articulating instruments, allowing surgeons to change the degree of articulation with a simple wrist movement is an appealing concept. However, this study, along with a previous study using a LAP model [12], failed to demonstrate any performance advantages with these novel D-ART instruments compared with STR instruments.…”

Single-incision laparoscopic surgery (SILS™) versus standard laparoscopic surgery: a comparison of performance using a surgical simulator

“…The FLS box-trainer and its metrics, developed from the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) trainer, have been validated extensively and shown to reliably predict technical skill in laparoscopic surgery [10][11][12][13][14]. Given its ability to measure performance objectively and quantitatively, the FLS box-trainer and its metrics have been used to assess the effects of novel instrumentation, techniques, and training regimens for laparoscopic surgery [15][16][17].…”

Assessment of joystick and wrist control in hand-held articulated laparoscopic prototypes

“…Moreover, it is difficult to perform technically demanding maneuvers, e.g., intracorporeal suturing and knot tying [3, 4]. To overcome the restriction in movements, various steerable instruments (also known as deflectable, rotatable, or articulated instruments) have been developed [5–9]. The advantage of these instruments compared with the conventional ones is that they provide sideways rotations of the tip.…”

“…Most of the mechanical manipulators use wrist control to perform rotations of the instrument tip [5, 8, 9, 12]. The Radius Surgical System (Radius) is an example of such a mechanical manipulator [5].…”

“…The Radius Surgical System (Radius) is an example of such a mechanical manipulator [5]. The wrist control also is used in the minimally invasive manipulator (MIM) developed by Jaspers et al [8], as well as in the commercially available Autonomy Laparo-Angle instrument [9]. In the study by Gossot and Lange [7], the tip of the instrument is steered by a single control wheel.…”