Introduction: Straight-shaped instruments used in conventional laparoscopic surgery have limitations, as they cannot use the wrist joint unlike in robotic surgery. The new multi degree-of-freedom articulating laparoscopic instruments named ArtiSential? (LIVSMED, Seongnam, Republic of Korea) obviate the limitations of straight-shaped instruments and allow the wrist joint to be used freely over 360° as in robotic surgery. We aimed to evaluate the performance doing renal surgery using ArtiSential? compared with da Vinci? surgical system or straight-shaped instrument in a porcine model.
Methods: Nine female Yorkshire pigs were divided into 3 groups: ArtiSential?, robotic and straight-shaped groups. Three groups were compared for surgical steps in terms of with objective and subjective parameters. Objective parameters included operation time, blood loss and intraoperative complication. Subjective parameters included accuracy of procedure judged by the reviewer, useability of instrument and musculoskeletal discomfort judged by the surgeon.
Results: Mean operative time for renal pedicle clamping and ureter dissection were significantly shorter in the ArtiSential? group compared to robotic group, respectively (1.4 min versus 5.5 min and 7.2 min versus 11.3 min). Mean operative time for bladder repair were significantly longer in the ArtiSential? group compared to robotic and straight-shaped groups, respectively (16.0 min versus 5.9 min versus 9.4 min). There were no significant between-group differences in blood loss. ArtiSential? was less usable for renorrhaphy and bladder repair compared to robotic group. ArtiSential? group was less accurate for tumor resection, renorrhapy and bladder repair compared to robotic group. The surgeon experienced less hand discomfort during ureter dissection in the ArtiSential? group compared to straight-shaped group. The surgeon experienced more wrist discomfort during renorrhaphy, renal pedicle ligation, ureter dissection, bladder cuff excision and repair in the ArtiSential? group compared to robotic group, but less back discomfort.
Conclusions: ArtiSential® is comparable for most steps to da Vinci? surgical system or straight-shaped instruments in terms of with objective and subjective parameters. Also, the development of specialized surgical techniques for ArtiSential? will maximize the advantages of these new instruments for suturing.
Source of Funding: ‘Supporting Project to Evaluate New Domestic Medical Devices in Hospitals’ funded by Ministry of Health and Welfare and Korea Health Industry Development Institute.
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.jpg "Jong Keun Kim, MD photo")