The EndoHand: Comparison with Standard Laparoscopic Instrumentation

Abstract

Laparoscopic instrumentation is constantly being refined in an attempt to achieve the proficiency, flexibility, and tactile feedback that would be available if the human hand were small enough to be used in laparoscopic surgery. The EndoHand (DAUM GmbH, Schwerin, Germany) is a novel laparoscopic three-fingered hand developed as an advancement over standard laparoscopic tools. Grasping and manipulation ability, dexterity, and tactile feedback were compared with those of current laparoscopic instrumentation. Experiments included measurement of achievable angles of approach to a fixed point behind a 2-cm-tall obstruction, completion time and error rates during a pelvic trainer dexterity task, and tactile feedback using a device invented to simulate tissue resistance. Subjectively, the EndoHand was able to pick up a range of objects similar to those graspable by a Babcock clamp. More complex types of manipulation were possible with the EndoHand because of its wrist joint. The range of approach angles to the fixed point was 35 degrees to 90 degrees with the EndoHand and 70 degrees to 90 degrees with the straight instruments. The dexterity of the EndoHand was significantly less than that of the other two instruments, as measured by time (P = 0.0002) and errors (P = 0.02). Standard instruments were also more accurate in the tactile feedback trials (P = 0.02). The EndoHand is a prototype of a unique new generation of laparoscopic instruments. Although it falls short in both dexterity and tactile feedback, significant promise is shown in its ability to perform sophisticated manipulation of objects and its flexibility to work at a larger range of angles to the target tissue. The EndoHand may be most useful on the nondominant hand of the surgeon to assist with positioning and holding tissue in a specific orientation. Clinical trials will determine its eventual role in laparoscopic surgery.

Objective assessment comparing hand-assisted and conventional laparoscopic surgery

“…Factors such as direct tactile feel and improved propioception have been suggested as reasons for the benefits realized with these instruments [5,7].…”

“…Laparoscopic instrumentation is constantly being refined in an attempt to achieve the proficiency, flexibility, and tactile feedback that would be available if the human hand were small enough for use in laparoscopic surgery [5]. This has allowed more and more complex surgery across a diversity of surgical specialties.…”

Laparoscopic tissue approximation

“…Not only will more exposure to laparoscopy during training result in more ecient application of current tissue approximation methods, but the experimental modalities discussed above will continue to be re®ned until they achieve clinical use. Advances in robotic surgery, [56] remote surgery, mechanical devices which mimic the human hand, [23] and even virtual reality, may one day all serve to completely change the way tissues are brought together laparoscopically.…”