Laser Guided Instrument Positioning

Introduction: A restricted visual field is a shortcoming of laparoscopic surgery. This limitation often leads to blind instrument insertion and can result in occult intra-abdominal injury. A navigation system which supports safe instrument use even outside of the camera’s view would be ideal. This study describes the use of a novel trocar system which employs a laser to track instrument movement.
Materials and Methods: A laser guided trocar system (Trocator™, MIS, NY, NY) was compared to standard trocars in an inanimate training module. The trainer box was equipped with a barrier installed out of camera view with cutouts designed to limit entry of the instruments and mimic commonly encountered impediments to instrument insertion such as adhesions and intra-abdominal organs.
The Trocator uses a 670nm laser and haptic feedback to detect entry trajectory and identify potential obstacles prior to instrument insertion. 20 subjects, representing a wide range of surgical expertise performed basic laparoscopic tasks with and without the laser trocar system. Time to completion of the tasks and number of collisions with the barrier were tabulated.
Results: The laser trocar system reduced the mean time to complete the laparoscopic tasks from 95.8 to 75.7 seconds (p=.026). This difference was most pronounced in subjects at earlier stages in their training. Even more significant, was the reduction in number of collisions with the barrier, which was reduced from a mean of 12.78 hits per task to 0, this difference was highly significant (P=.00006).
Conclusions: Laser augmented instrument insertion significantly improves safety and may also help novices shorten their learning curve.

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