Matthew C Rade, MD, Aaron Berkenwald, MD, Desmond H Birkett, MD, Dmitry Nepomnayshy, MD. Lahey Hospital and Medical Center
Introduction: In order to perform certain laparoscopic procedures, a surgeon requires an extra assistant to hold the camera. Problems with this approach include table crowding which leads to poor ergonomics, miscommunication leading to poor image targeting and image stability, and increased cost of having extra staff in the O.R. We wanted to assess if the AutoLap system, a novel robotic laparoscope positioner could address these concerns. This study reports set up time, ergonomics and image stability data using this device.
Methods and Procedures: Data included set up time, ergonomics and usability (via nurse, surgeon and camera holder questionnaire) and image stability recorded via the Inertial Measurement Unit (IMU), an attachable sensor, describing linear acceleration (in units gravity [g]) and horizontal acceleration (Angular Velocity in rad/sec). The 70% nosiest sections of camera movements were removed, leaving the steadiest sections for analysis between human and Autolap. After 20 warm-up procedures, 26 patients were divided between the human and robotic arm of the study.
Results: Angular velocity and linear acceleration were better for the robotic camera holder. Median angular velocity was 0.029 and 0.005 rad/sec for human camera holder and AutoLap system, respectively (p-value <0.001). Linear acceleration was 0.011 and 0.007 [g] (p-value 0.015). Positive feedback included greater surgeon comfort (92%) and nursing staff reported improved interaction with surgeon (100%) as well as more efficient procedure (92%) with AutoLap. Negative comments included difficulties connecting the camera to the holder and inefficient device set up. During training cases, the average setup time was 8.25mins with a standard deviation of 3 mins. For study cases, the average setup time was 7.27 mins +1.25 mins. Interestingly, 54% of human camera holders reported discomfort in their arm, back or neck throughout the procedure.
Conclusions: The AutoLap system provides improved image stability, staff interactions, and enhanced ergonomic comfort for the surgical team. It also offers cost-savings from decreased staffing requirements for hospitals that routinely use staff camera holders. The system set up of 7-8 minutes was less variable after 20 cases, representing the learning curve. In addition, our approach identified problems with the system that require improvement by the manufacturer. Notably, we identified significant ergonomic problems for human camera holders, which has been previously described and can be addressed by this device.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88127
Program Number: P491
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster