Kent C Bowden, DO, FACOS. Munson Healthcare Cadillac
Background: Although the high cost and steep learning curve of implementing a Robotic Surgical program are well established, the adoption rate of robotic surgical systems in general surgery continues to grow, with suture-intensive procedures driving this adoption. The core enabling technologies of the daVinci “robotic” System are the intuitively controlled wristed instruments and 3D laparoscopic vision. We aimed to evaluate if “robotic-like” functionality may be achieved through the integration of two novel technologies, the FlexDex Needle Driver (FlexDex Surgical, a University of Michigan) and ENDOEYE FLEX 3D (Olympus, Tokyo, Japan).
Method: Surgeon training on the FlexDex Needle Driver combined with ENDOEYE FLEX 3D laparoscopic system was conducted at our institution in May 2017. Several hours of training in a laparascopic training box were completed to ensure competency and accuracy. Focusing on preparing for procedures where general surgeons are commonly using the daVinci System. We performed an initial case series in June 2017, we have over 50 cases in our experience. This included inguinal hernias, ventral hernias and reflux procedures. We assessed if technical obstacles of laparoscopic suturing were decreased and if laparoscopic skills overall were improved. Surgical outcomes were compared relative to our historic values; we assessed procedure time and operating room efficiency, including set up and turn-over times.
Results: Overall, the 3D/FlexDex system permitted a greater improvement in working speed, superior optical visualization, and better suture handling compared to standard laparoscopy. All surgeries were completed without any complications. Historically, we considered laparoscopic suturing to be complicated and inefficient. We relied on tacking devices for mesh fixation, suturing was previously completed with large cumbersome straight laparascopic devices. However, with FlexDex and ENDOEYE FLEX 3D, tacking devices have been eliminated and suturing technique improved. The mean total procedure times remained comparable for inguinal and hiatal hernia surgeries, and slightly longer for ventral hernias. Operating room efficiency, including mean set up and turn-over times also remained unchanged. The acquisition cost for both the Olympus ENDOEYE FLEX 3D laparoscopic imaging system and the disposable cost of the FlexDex Needle Driver are comparable to contemporary instruments.
Conclusion: In our initial experience, the 3D/FlexDex system promises significant improvement in laparoscopic skills through intuitive control, a short learning curve and eliminating technical obstacles of laparoscopic suturing. Furthermore, it offers robot-like suturing while avoiding the associated cost and complexity of a robotic surgical system.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87350
Program Number: P791
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster