Francisco Miguel Sánchez Margallo, PhD1, Juan A. Sánchez-Margallo, PhD1, Andreas Skiadopoulos, PhD2, Konstantinos Gianikellis, PhD3. 1Minimally Invasive Surgery Centre, Cáceres, Spain, 2University of Nebraska at Omaha, 3University of Extremadura, Spain
INTRODUCTION: New handheld devices have been developed in order to address the technical limitations and ergonomic issues present in laparoscopic surgery. The aim of this study is to analyze the surgeon’s performance and ergonomics using the Radius r2 DRIVE instruments (Tubingen Scientific Medical, Germany) during the execution of laparoscopic cutting and suturing tasks.
METHODS AND PROCEDURES: Three experienced laparoscopic surgeons performed both an intracorporeal suturing task and a cutting task on a box trainer. Both tasks were repeated three times. A Maryland dissector and a pair of scissors were used for the cutting task. For the suturing task, a Maryland dissector and needle holder were used. Conventional laparoscopic instruments and their equivalent r2 DRIVE instruments were used. The order in the use of the type of instruments was randomized. Execution time and surgeon’s ergonomics were assessed. For the latter, surface electromyography (trapezius, deltoid and paravertebral muscles) and the NASA-TLX index were analyzed. For the cutting task, the percentage of the area of deviation from the cutting pattern (% of error) was assessed. The suturing performance was assessed by means of a task-specific validated checklist.
RESULTS: Surgeons required more time to perform both laparoscopic tasks using the r2 DRIVE instruments. The use of both instruments had a similar percentage of deviation from the exterior part of the cutting pattern. However, the deviation from the inner part was significantly higher using the r2 DRIVE instruments (Conv: 7.9±1.3% vs r2 DRIVE: 10.8±2.1%; p<.05). Needle driving was scored lower using the r2 DRIVE instruments, but quality of knot tying was similar to conventional instruments. The use of r2 DRIVE increased the muscle activity of the trapezius muscles bilaterally for both laparoscopic tasks. This muscle activity also increased for the left deltoid muscle during the cutting task. Surgeons stated that the use of r2 DRIVE instruments leads to a higher mental and physical workload when compared to traditional laparoscopic instruments.
CONCLUSIONS: Despite the novel and ergonomic design of the r2 DRIVE laparoscopic instruments, the results of this study suggest that an improvement in surgical performance and physical workload is required prior their use in an actual surgical setting. Further studies should be done to analyze the use of these instruments during other laparoscopic tasks and procedures. We believe that surgeons need a longer and comprehensive training period with these laparoscopic instruments to reach their full potential in laparoscopic practice.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87884
Program Number: P506
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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