Emily Dorian, Francis J DeAsis, BS, BA, Ryota Tanaka, MD, PhD, Brittany Lapin, MPH, Robert Amesbury, JoAnn M Carbray, BS, Michael B Ujiki, MD. NorthShore University HealthSystem Evanston Hospital
Background
Mini laparoscopy (ML) is an emerging minimally invasive technique that aims to improve upon standard laparoscopy in the areas of tissue trauma, pain and cosmesis. ML instruments are 3mm in diameter or less compared to traditional 5mm diameter laparoscopic instruments. The miniaturized instruments accommodate mini ports and small trocar incisions that aim to improve outcomes. The objective of this study was to determine if there was a difference in functionality between two novel ML instruments when compared to standard laparoscopic tools. The primary difference between the ML instruments was assembly, as both tools use different methods for the operator to change the toolhead. Differences between the ML instruments and the standard instruments were assessed in a simulated surgical environment.
Methods
Eighteen participants (5 novices, 10 residents, 3 attendings) were recruited for this IRB-approved study in a surgical simulation training center. After completing a demographics sheet, participants were shown how to assemble the ML tools. Group A ML tools were assembled intracorporeally, while Group B ML tools were assembled extracorporeally. Then, using standard laparoscopic graspers, ML graspers or a combination of both, each participant performed 3 basic laparoscopic training tasks: a Peg Transfer (based on the Fundamentals of Laparoscopic Surgery™ Program), Rubber Band Stretch, and Tootsie Roll™ Unwrapping. Participants were scored based on time to task completion. Assembly and disassembly time of the ML graspers was also recorded. Following each round of tasks, participants completed a survey evaluating the ML graspers with respect to standard laparoscopic graspers. Chi-square test, Analysis of Variance (ANOVA) and Tukey’s post-hoc test was used to analyze the data.
Results
On average, a novice had zero laparoscopic experience, residents had between 25-50 cases, and attendings had over 1000 cases (p= <.0001). When comparing task times, both ML tools performed at the level of the standard laparoscopic graspers in all participant groups (Table 1). Group A tools were quicker to assemble and disassemble versus Group B tools (Table 1).
| Group A | Group B | Standard | p-value | |
| Peg Transfer (sec) | 127.9 ± 71.5 | 108.9 ± 38.1 | 100.9 ± 44.3 | 0.303 |
| Rubber Band Stretch (sec) | 148.7 ± 78.9 | 182.7 ± 98.4 | 134.0 ± 101.4 | 0.285 |
| Tootsie Roll™ Unwrapping (sec) | 127.4 ± 76.9 | 110.9 ± 43.8 | 129.5 ± 76.1 | 0.664 |
| Assembly (sec) | 38.53 ± 29.22 | 74.42 ± 24.70 | n/a | <.0001 |
| Disassembly (sec) | 27.32 ± 24.12 | 39.81 ± 33.24 | n/a | 0.02 |
According to post-task surveys, all participant groups indicated that both sets of ML graspers were comparable to the standard graspers when evaluated on Maneuverability, Strength, Efficiency, Structure, and Overall Function.
Conclusion
In a non-clinical setting, ML instruments perform at the level of standard laparoscopic tools. The ML tools with intracorporeal assembly were also quicker to assemble than those with extracorporeal assembly.