Antonello Forgione, MD, Ivo Broeders, MD, Amir Szold, MD. Assia Medical Group, Tel Aviv, Israel, AIMS Academy, Niguarda Ca Granda Hospital, Milan, Italy, and MEander Medical Center, Amersfoort, Netherlands.
Objectives: Camera manipulation in laparoscopic surgery is often in the hands of an unskilled assistant and the control by the surgeon is low. In addition, many times during the operation the laparoscope needs to be removed and cleaned, usually from “smudging” occurring by the assistant touching tissue with the scope inadvertently. We designed and built a novel, image based active camera manipulator that replaces the human assistant and ensures steady visualization of the operative field, and full control by the surgeon. The performance and use of the AutoLap system, has been investigated in various laparoscopic procedures.
Technology and Methods: The AutoLap system is a low profile active laparoscopic manipulator that can be attached to standard operating room tables. Installing the system is fast, simple and requires no calibration prior to procedure initiation. The AutoLap's image processing algorithms ensure accurate directional movements in any camera spatial position and maintaining the field of view while zooming in and out even when using 300 laparoscopes. The surgeon controls the laparoscope movements by a miniature, disposable radio frequency button that may be attached to the surgeon's finger or the laparoscopic instrument. The system holds the laparoscope steadily, until movement is initiated by a single button press. The same button is used for initiating and stopping movements in all directions, including zooming in and out, thus the field of view is under the sole control of the surgeon using a single button.
After validation in animals the AutoLap system has been used in 17 laparoscopic procedures in patients, performing cholecystectomy and Nissen fundoplication. The system's set up time and number of times that the laparoscope was taken out for cleaning were measured. Comfort and ease of use for the surgeon were evaluated using a questionnaire (scale 1–5; 1 ‘‘poor’’, 5 ‘‘excellent’’).
Results: All procedures were successfully completed without complications. Average set up time was 6 minutes and the laparoscope was rarely removed for cleaning. High satisfaction from the use of the system was presented by all surgeons who used the system (questionnaire median score level of 4).
Conclusion: The use of sophisticated image processing algorithms that enable accurate response and complete surgeon's control of the desired field of view without relying on an assistant seems possible with the AutoLap system. The flexible software structure of the AutoLap system enables incorporating additional image processing algorithms that will enable additional modes of movements' control.