Problems with Laparoscopic Instruments: Opinions of Experts

Abstract

Introduction: Laparoscopic surgery is particularly known for its complex technique, which calls for operative analysis of laparoscopic instruments. This study investigates the opinion of experts about clinical problems with instruments occurring during laparoscopic surgery.Methods: A questionnaire was used to obtain the opinions of expert laparoscopic surgeons about difficulties experienced operatively using laparoscopic instruments.Results: The laparoscopic surgeons indicated that coagulators were especially prone to cause complications of the gastro-intestinal tract, vascular injuries, and bile duct injuries. Dissectors were considered to play a role in the occurrence of solid organ and bile duct injuries, and retractors to cause solid organ injuries. Insufficient functionality of the instruments and insufficient quality of the image were indicated to contribute to the instrument's risks. Conclusion:The questionnaire identified technological deficiencies prone to cause operative complications. The results provide a basis for the interaction between surgeons and engineers, and serve as pilot information on which to base an in-depth object evaluation of instrument problems.

Advancement and benefit of energy sealing in minimally invasive surgery

“…Choice of advanced energy device encompasses multifunctionality, including vessel sealing, grasping, blunt dissector, and ergonomics such as scissor, pistol or pen grip, and length of shaft. Overall, firm, reliable, simple instruments that allow the surgeon to focus on the technical aspects of the procedure are favored in this field; reusable instruments are also favored because of lower costs . Cordless instruments obviate complications due to wires.…”

“…Cordless instruments obviate complications due to wires. Coagulators were reported as having higher incidences of gastrointestinal, vascular or solid organ injury than dissectors or grasping forceps in a survey of 20 surgeons’ experience over 10 years . A limited working space with less tactile feedback, color and depth perception than open surgery, limited field of vision, and increased wetness of the operating field contributes to the need for optimization of the instruments.…”

Enhanced visuomotor learning and generalization in expert surgeons

“…Laparoscopic or minimally invasive surgery (MIS) is rapidly replacing traditional open surgery for many procedures due to its major benefits for patients over conventional open surgery including reductions in infection risks, recovery times, scarring, and overall hospital stays [3]. Despite these advantages, the task environment in MIS places high demands on surgeons, increasing the difficulty relative to open surgery for both initial learning [4] and ongoing performance [3,5,6]. Since laparoscopic instruments are controlled through small insertion points in the skin, instrument movements are often mirror-reversed and counter-intuitive (e.g., leftward hand motion produces rightward instrument tip motion, and vice versa).…”

Laparoscopic suturing learning curve in an open versus closed box trainer

“…Simulator training programs are widely implemented into surgical, urological and gynecological resident curricula [ 5 , 6 ]. Some of the challenges that MIS poses to surgeons and surgeons in training are: loss of depth perception and special orientation due to two-dimensional (2D) vision [ 7 – 9 ], perceived inversion of movement from the handle to the working end of the instrument “the fulcrum effect of the abdominal wall” [ 10 – 12 ], loss of haptic feedback due to resistance inside the trocars [ 13 ] and the use of long laparoscopic instruments [ 14 ], limited motion freedom and degrees of freedom (DOFs) due to the use of long rigid instruments [ 9 , 12 ]. …”

“…limited motion freedom and degrees of freedom (DOFs) due to the use of long rigid instruments [ 9 , 12 ].…”