Safe implementation of hand held steerable laparoscopic instruments: a survey among EAES surgeons

Abstract

The complexity of handheld steerable laparoscopic instruments (SLI) may impair the learning curve compared to conventional instruments when first utilized. This study aimed to provide the current state of interest in the use of SLI, the current use of these in daily practice and the type of training which is conducted before using SLI in the operating room (OR) on real patients. An online survey was distributed by European Association of Endoscopic Surgery (EAES) Executive Office to all active members, between January 4th and February 3rd, 2020. The survey consisted of 14 questions regarding the usage and training of steerable laparoscopic instruments. A total of 83 members responded, coming from 33 different countries. Twenty three percent of the respondents using SLI, were using the instruments routinely and of these 21% had not received any formal training in advance of using the instruments in real patients. Of all responding EAES members, 41% considered the instruments to potentially compromise patient safety due to their complexity, learning curve and the inexperience of the surgeons. The respondents reported the three most important aspects of a possible steerable laparoscopic instruments training curriculum to be: hands-on training, safe tissue handling and suturing practice. Finally, a major part of the respondents consider force/pressure feedback data to be of significant importance for implementation of training and assessment of safe laparoscopic and robotic surgery. Training and assessment of skills regarding safe implementation of steerable laparoscopic instruments is lacking. The respondents stressed the need for specific hands-on training during which feedback and assessment of skills should be guaranteed before operating on real patients.

Commentary: Endoscopic Endonasal Removal of a Laterally Extended Pituitary Adenoma Using Steerable Forceps: 2-Dimensional Operative Video

“…Although the video demonstrates a clear benefit of using steerable forceps for accessing difficult areas of the parasellar region, operators of steerable forceps may encounter steep learning curves to become proficient in using the instrument. 20 Therefore, additional training and careful incorporation of the surgical instrument into one's practice is necessary. Alternatively, the development of other instruments that combine flexibility with more retained structure may lower the learning curve yet offer the benefits of added freedom in surgical instruments.…”