Low-Friction Minilaparoscopy Outperforms Regular 5-mm and 3-mm Instruments for Precise Tasks

Abstract

Background and Objectives:Therapeutic laparoscopy was incorporated into surgical practice more than 25 y ago. Several modifications have since been developed to further minimize surgical trauma and improve results. Minilaparoscopy, performed with 2- to 3-mm instruments was introduced in the mid 1990s but failed to attain mainstream use, mostly because of the limitations of the early devices. Buoyed by a renewed interest, new generations of mini instruments are being developed with improved functionality and durability. This study is an objective evaluation of a new set of mini instruments with a novel low-friction design.Method:Twenty-two medical students and 22 surgical residents served as study participants. Three designs of laparoscopic instruments were evaluated: conventional 5 mm, traditional 3 mm, and low-friction 3 mm. The instruments were evaluated with a standard surgical simulator, emulating 4 exercises of various complexities, testing grasping, precise 2-handed movements, and suturing. The metric measured was time to task completion, with 5 replicates for every combination of instrument–exercise–participant.Results:For all 4 tasks, the instrument design that performed the best was the same in both the medical student and surgical resident groups. For the gross-grasping task, the 5-mm conventional instruments performed best, followed by the low-friction mini instruments. For the 3 more complex and precise tasks, the low-friction mini instruments outperformed both of the other instrument designs.Conclusion:In standard surgical simulator exercises, low-friction minilaparoscopic instruments outperformed both conventional 3- and 5-mm laparoscopic instruments for precise tasks.

Giant Nonparasitic Splenic Cyst Managed by Minilaparoscopy

“…21 Compared with conventional laparoscopy, minilaparoscopy has the advantages of causing less trauma to the abdominal wall and, consequently, less postoperative pain, requiring shorter hospital stay, providing better visualization of the surgical field, and enabling more precise movements. Firme et al 22 showed that for gross grasping tasks, the conventional 5-mm instruments are better, but for more precise and complex movements, the low-friction 3-mm instruments performed best. These conclusions lead to the possibility of preserving more splenic tissue, particularly in the present case.…”

Minilaparoscopy For Inguinal Hernia Repair

“…Trocar dislocation and skin reinsertions were significantly diminished, consequently reducing abdominal trauma, resulting in less pain and improved aesthetics. 1 , 7 , 9 , 10 , 18 – 21 ( Figure 3 ) This technique of mini-TEP without mesh fixation also entails a considerable reduction in cost, because it does not use expensive meshes, disposable instruments, the fragile 3-mm laparoscope, sutures, glue, or tackers, and hence it is possible to perform this type of repair on a larger number of patients to their advantage. 1 , 7 , 8 , 10 …”

“…An important feature of minilaparoscopic surgery, the decreased surgical trauma is achieved by the reduction in diameter of the laparoscopic instruments and trocars. 18 – 20 This improvement is obtained with the maintenance of range of motion in triangulation throughout surgery. Along with the benefit of low-friction trocars, minilaparoscopy has the potential of improving ergonomics and, therefore, provides the surgeon the precision that is needed.…”

“…Along with the benefit of low-friction trocars, minilaparoscopy has the potential of improving ergonomics and, therefore, provides the surgeon the precision that is needed. 5 – 7 , 9 , 10 , 18 – 22 …”

“…Enhanced visualization achieved with the mini is remarkable, allowing easier identification of the structures facilitating procedures such as TEP inguinal hernia repair. 9 , 10 , 18 – 22 …”