Multi-DOF (Degree of Freedom) Articulating Laparoscopic Instrument is an Effective Device in Performing Challenging Sutures

Abstract

Although laparoscopic surgery had been performed in clinical practice for over 30 years, there has not been much improvement on instruments. Several articulating laparoscopic instruments have been developed including the robotic system. A new multi-degree of freedom (DOF) articulating laparoscopic device has been developed. We compared the ability to perform challenging sutures between the new device and the robotic system. Methods: Five experienced surgeons with over 100 laparoscopic surgery cases performed the suture task with both instruments. Everyone was new at articulating instruments including a robotic system. The suturing task consisted of two vertical sutures, downward and upward vertical direction. The duration of needle grabbing, first surgical tie, square tie, and the final reverse tie was measured. Results: When doing the downward suture, the median time to complete the suture was 127 vs. 136 seconds for ArtiSential ® and the robot, respectively (p=0.754). Other measurements such as needle grabbing, first tie, second tie and final knot did not show any significant difference between the two instruments. Upward suture also did not show a significant difference. The total completion time was 127 vs. 112 seconds for for ArtiSential ® and the robot, respectively (p=0.675). Time taken in each interval did not show any significant difference. Conclusion: Both instruments performed the suturing tasks with no difference in duration. ArtiSential ® can be mixed up with usual instruments. Surgeons can choose any device, but when articulation is needed, ArtiSential ® could be an alternative choice to the robotic system.

Surgeon-Powered Robotics in Thoracic Surgery; An Era of Surgical Innovation and Its Benefits for the Patient and Beyond

“…In all, this contributes to increased precision when compared to VATS, due to the dexterity of a robotic instrument, with added tactile feedback. There are also ongoing attempts to develop technology for the integration of enhanced tactile sense (5). However, due to the wired articulating joint mechanism of the ArtiSential R wristed instruments, resistance from the tissue or tension during knot tying (6), can be sensed between the jaws of the instrument (5).…”

“…There are also ongoing attempts to develop technology for the integration of enhanced tactile sense (5). However, due to the wired articulating joint mechanism of the ArtiSential R wristed instruments, resistance from the tissue or tension during knot tying (6), can be sensed between the jaws of the instrument (5). This in contrast to the lack of haptic feedback exerted by the da Vinci R system.…”

“…Such flexibility is extended by the option to utilize both wristed and traditional instruments if desired. It may be that the surgeon wishes to exploit the increased dexterity of the ArtiSential R during a difficult case, when transitioning to the da Vinci R is simply unfeasible (5).…”

Is it Beneficial to Utilize an Articulating Instrument in Single-Port Laparoscopic Gastrectomy?

“…However, because of the bent shape of the instrument, the entire shaft of the instruments is off-screen during most of the procedure, impeding intuitive control, especially for novice surgeons [ 13 ]. Meanwhile, articulating devices with increased freedom in movement are being developed, and the ArtiSential ® device (LivsMed) is the first multi-DOF articulating laparoscopic device with a 360° angle of motion [ 26 ].…”

Single-Incision Proximal Gastrectomy With Double-Flap Esophagogastrostomy Using Novel Laparoscopic Instruments

“…Also, articulating needle holders such as the ArtiSential needle holder (Livsmed, Korea) were able to reduce the anastomosis time and helped in performing an accurate suture without disrupting the anastomosis. This device showed equal suture time compared to the da Vinci system in a previous dry lab study 7 and was introduced to clinical cases since 2018. 8…”