A randomized comparison of laparoscopic, magnetically anchored, and flexible endoscopic cameras in performance and workload between laparoscopic and single-incision surgery

Abstract

The data suggest that the improved imaging element of the next-generation MAGS camera has optical and performance characteristics that meet or exceed those of the LAP or ENDO systems and that the MAGS camera may be especially useful for SSL. Further refinements of the MAGS camera are encouraged.

Fine Tilt Tuning of a Laparoscopic Camera by Local Magnetic Actuation

“…To provide a direct comparison with LMA camera tilting performance, a magnetic camera based on the prototype described in Arain et al 6 was fabricated. This mock-up embedded a 3-mm fixed-focus medical imaging element (Medigus Ltd, Omer, Israel) placed with a 30° downward-looking orientation, 2 LEDs with 40 lumens of brightness each, and 2 diametrically magnetized N42 NdFeB cylindrical permanent magnets (9.5 mm in diameter and 9.5 mm in length) housed in a rapid prototyping cylindrical plastic case (15 mm in diameter and 80 mm in length, 40 g in weight; Figure 2B).…”

“…Secondary end points were the time required to perform the procedure, the number of times that the LMA tilt mechanism was activated, and the time that the camera point of view was tilted more than 30° downward. This last parameter quantifies the reduction in workload with respect to a state-of-the-art magnetic camera (ie, the camera described in Arain et al 6 has a 30° downward-looking angulated lens; thus, focusing on a target at an angle larger than 30° requires the operator to apply a pressure on the patient's abdomen). A total of 5 nephrectomies (1 left and 4 right) were performed on 4 different cadavers.…”

“…Because of its ability to embrace the abdominal wall and being unconstrained by the entry incision, a MAGS camera can increase surgical visualization and provide panoramic and unconventional views of the surgical field from multiple angles. 6 Despite these clear advantages, current magnetic devices present some drawbacks mainly related to the limited motion range that can be achieved by manual control of the handle. Motion along the inflated abdomen, guaranteed by the coupling between the external and the internal magnets, can result in rough and jerked movements of the camera because of dynamic/static friction at the interface with the abdominal wall.…”

“…Motion along the inflated abdomen, guaranteed by the coupling between the external and the internal magnets, can result in rough and jerked movements of the camera because of dynamic/static friction at the interface with the abdominal wall. Moreover, tilting of the point of view downward or upward can be obtained only by constantly applying pressure to deform the abdomen, 6,7 resulting in a relevant workload for the operator, potential vibrations, and the risk of losing the desired view of the target. To overcome these problems and achieve a precise and expanded tilt motion, the concept of local magnetic actuation (LMA) can be applied.…”

Electropermanent Magnetic Anchoring for Surgery and Endoscopy

“…Magnet-assisted resection and dissection has been demonstrated by a number of groups and magnetic assistance has been proposed in single site laparoscopic surgery access and manipulation of internal targets. One of the first and most developed magnetic assistance systems is the University of Texas Southwestern Medical Centre system called MAGS (Magnetic Anchoring and Guidance System) [1]- [9]. The original MAGS was mainly for camera manipulation in abdominal surgery.…”