Francisco M. Sánchez Margallo, PhD1, Juan A. Sánchez Margallo, PhD1, Andreas Skiadopoulos, PhD2, Konstantinos Gianikellis3. 1Minimally Invasive Surgery Centre, Cáceres, Spain, 2University of Nebraska at Omaha, 3University of Extremadura, Spain
INTRODUCTION: The aim of this study is to analyze the surgeon’s performance, workload and ergonomics using an ergonomically designed handheld robotic needle holder during laparoscopic urethrovesical anastomosis in an animal model, and comparing it with the use of a conventional laparoscopic needle holder.
METHODS AND PROCEDURES: Six experienced surgeons performed an urethrovesical anastomosis in a porcine model using a handheld robotic needle holder and a conventional laparoscopic axial-handled needle holder (Karl Storz GmbH). The robotic instrument (DEX®, Dextérité Surgical) has an ergonomic handle and a flexible tip with unlimited rotation, providing seven degrees of freedom. The use of the surgical instrument was randomized. For each procedure, an expert surgeon evaluated the surgical performance in a blinded fashion using the Global Operative Assessment of Laparoscopic Skills rating scale. Besides, the quality of the intracorporeal suture was assess by a validated suturing-specific checklist. The surgeon’s posture was recorded and analyzed using the XSens MVN BIOMECH system based on inertial measurement units. The surgeon’s workload was evaluated by means of the NASA Task Load Index, a subjective, multidimensional assessment tool. The patency of each anastomosis was assessed using Methylene blue.
RESULTS: All urethrovesical anastomoses were completed without complications. Only one anastomosis with the robotic device failed the patency test. Surgeons showed similar surgical skills with both instruments, although they presented greater autonomy with the conventional instruments (p = .048). For the suturing performance, the use of the robotic device led to an increase in the number of movements during the needle driving and lower tendency to follow its curvature during the withdrawal maneuver (p = .007). The level of workload increased with the robotic device. However, the surgeon's satisfaction with the surgical outcome did not differ using both instruments. The use of the robotic instrument led to similar posture of the shoulder and wrist and better posture of the right elbow (p = .026) when compared to the conventional instrument.
CONCLUSIONS: The use of the robotized needle holder obtained similar results for the surgical performance and surgical outcome of the urethrovesical anastomosis when compared to the conventional instrument. We consider that aspects such as the surgeon’s autonomy, dexterity in driving the needle and workload could be improved with a comprehensive training with the new device. Inertial sensors can be an alternative for actual and crowded surgical environments. Surgeons acquired a better body posture using the novel robotic needle holder.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87872
Program Number: P509
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster