A Multitasking Platform for NOTES; A Bench Top Comparison of a New Device for Flexible Endoscopic Surgery and Standard Dual Channel Endoscope * *supported By a Noscar Grant (2006)

Background: Complex surgery requires precise, independent coordination of two instruments that can perform multiple tasks such as traction and counter traction, precise dissection, and tissue approximation. All of these are difficult to achieve with standard dual channel scopes, which have been used for most of the human NOTES cases today. The development of a multitasking platform is considered essential for the advancement of NOTES. A new endoscopic platform with two independent end-effectors, each with 5 degrees of freedom, and an ergonomic user interface has been developed to address these needs. We hypothesized that this new platform would improve performance for bimanual coordination compared to a standard dual channel scope.
Methods: Task 1 required 12 individuals to perform an identical bimanual bench top coordination task with 2 different devices: a dual channel endoscope (GIF 2T160) and the EndoSamurai prototype (both Olympus, Tokyo, Japan). Participants were separated into 3 groups: novice endoscopists (n=2), surgeons with less than 1000 endoscopies (n=7), surgeons with NOTES experience and more than 1000 endoscopies (n=3). A complex bimanual coordination task was used (Pin transfer). A total of 12 pins had to be placed in a predetermined order. Performance was measured by movement speed and accuracy. Comparisons were made between the 2 devices and the 3 groups. Task 2 was to test the feasibility of performing a reliable intracorporeal suture in a NOTES simulation. This task was only feasible with the EndoSamurai. Task performance was contrasted between the 3 groups participants.
Results: Task 1: Overall performance speed was significantly faster using the EndoSamurai (304+/-125 sec vs. 867+/-312 sec; P < 0.001). In detail (time in seconds): (experts: 226+/-41 vs. 620+/-277; surgeons: 333+/-152 vs. 930+/-283; students: 318+/-83 vs. 1021+/-423). Also accuracy (the number of pin drops) was significantly better using EndoSamurai (0.4 vs. 1.8; P = 0.006).
Task 2: All 12 participants completed a reliable suture using the EndoSamurai (experts: 275+/-35 sec; surgeons: 482+/-143 sec; students 558+/-384 sec).
Conclusions: The EndoSamurai enhances performance times in complex surgical tasks, compared to the conventional therapeutic endoscope. Independent movement of 2 instruments, each with extra degrees of freedom, seems critical to the design of new surgical operating systems for NOTES.

Session: Podium Presentation

Program Number: S074

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