Evaluation of the Surgeons Perception Comparing Conventional and Minilaparoscopic Instruments to Perform a Transanal Endoscopic Microsurgery (tem)

Diego Lima, MD, Gustavo Carvalho, PhD, Sergio Araujo, PhD, Ramon Mendes, MD, Armando Melani, MD, Carlos Veo, MD, Marcos Lyra, MD, Adriano Sales, Student

University of Pernambuco – Recife, Pernambuco – Brazil; UNIPECLIN, Universitary Hospital Oswaldo Cruz

BACKGROUND: Transanal endoscopic microsurgery (TEM) offers advantages over conventional transanal excision techniques of rectal lesions, mainly better visualization and exposure. However, despite its introduction more than 30 years ago, TEM widespread adoption could not yet be verified. Associated technical complexity may partially be involved in this issue. Therefore, there may be a role for instrument refinement in order to lessen the learning curve associated to TEM. TEM procedures have been successfully performed in Humans using the new minilaparoscopic low-friction trocars used in conjunction to 3-mm instruments. However, no study assessed surgeons’ perception associated to this novel approach compared to the conventional instrument set was conducted.

OBJECTIVE: To assess comparative surgeons perception of technical feasibility of TEM main steps using conventional 5-mm and low-friction 3-mm instruments during a single session in the TEO neoderma simulator®.

MATERIALS AND METHODS: Eighteen surgeons recruited during the 2012 Annual Meeting of The Brazilian Society of Laparoscopic Surgery were invited to complete a task in the TEO neoderma simulator®. The task was to resect a polypoid tumor and close the consequent defect using 5-mm conventional TEO instruments and afterwards the new 3-mm low friction instruments without previous instruction. The Simulator used was the TEO Neoderma trainer. Neoderma is a synthetic material offering color, touch, consistency and texture similar to human tissues. Every TEO simulator consists of a 30 cm-long and 4 cm-wide cylinder, naturally self-expanded and closed at one end, simulating a gas-inflated rectum. The present surgical model is manufactured with three 2 cm-size each polypoid tumors. The surgeons fulfilled a questionnaire regarding their impressions during the training comprising seven questions with answers adjusted to a Likert scale (1 to 5). For all seven questions regarding surgeons’ experience with the 5 mm instruments, the answer was considered to be 3 by default. When registering experience with the 3mm instruments, surgeons could point out a worst (1-2) or better (4-5) experience, when compared to conventional 5 mm equipment.

RESULTS: 88 % of surgeons pointed out grade 5 regarding if the instrument diameter (3mm) is adequate for the proposed task; 100% pointed out that their movements were more precise with 3 mm forceps resulting in grades 4 and 5 (50% each). 94,4% felt more comfortable to complete the task (grades 4 and 5). Only one surgeon (5,6%) pointed out that the result was the same as expected for conventional 5mm forceps. 83,3% recorded that it was easier to perform the procedure with the 3 mm forceps. About the flexibility of the material interfering with the task 94,4% recorded grades 4 and 5. 100% of the surgeons agreed that minilaparoscopic instruments offered superior visualization for the proposed task.

CONCLUSIONS: minilaparoscopic low-friction 3-mm instruments offered better visualization and were more reliable according to surgeons’perception during task performance in a Neoderma TEO simulator. With mini instruments it was easier and more comfortable to do complete the procedure when compared with the conventional TEO instruments.

Session: Poster Presentation

Program Number: P175

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