Instrument Tip Displacements during Manual and Powered Laparoscopic Stapler Use

Donald R Peterson, PhD, MS, Tarek Tantawy, MS, Drew Seils, MS, Angela S Kueck, MD

University of Connecticut Health Center

Manual laparoscopic staplers can require very high user activation forces during stapler firing, which can lead to excessive movement of the instrument tip and increase the potential for tissue damage. Powered laparoscopic staplers require very little user activation force and promote a significant decrease in overall tip movement. The goal of this study was to determine the difference in tip movement between a commonly-used manual stapler and a fully-powered stapler. Using a 24-camera opto-electronic motion capture system, surgeon postures and instrument tip displacements were tracked on 10 experienced laparoscopic surgeons performing staple firing simulations with each instrument on indicated tissue surrogates (i.e., foam) situated in a custom-built laparoscopic trainer having no walls. Simulations were performed in positions representing neutral and awkward postures commonly observed in laparoscopic surgeries and none of the subjects had any prior experience in using powered staplers. The total distance traveled by the tip during a complete firing sequence was calculated for each trial. When comparing staplers, results show that each subject was observed to have lower mean tip displacements and smaller displacement volumes (i.e., volume defined by two standard deviations about the displacement mean) for the fully-powered stapler. In addition, the standard deviations of tip displacements were, in general, lower for the fully-powered stapler. The overall mean tip displacement for the fully-powered and manual staplers were calculated to be 11.18cm and 31.66cm, respectively, which suggests a 65% reduction in tip movement and a potential reduction in tissue stress and/or damage caused by excessive tip movement when using a powered stapler.

Session: Poster Presentation

Program Number: P397

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