Abstract
BackgroundSurgeons have widely adopted endoscopic suturing techniques using conventional laparoscopic instruments and the more advanced robotic systems. The FlexDex is a novel articulating laparoscopic needle driver providing enhanced dexterity in laparoscopic surgery. This study evaluates and compares the learning curve of endoscopic suturing with conventional laparoscopy, the FlexDex and robotic suturing in novices.MethodsParticipants performed a minimal invasive suturing task in three different ways in a randomized order: with a conventional laparoscopic needle driver, using the FlexDex needle driver and third, using the Da Vinci Si surgical system. Primary outcome was suturing task time. Secondary outcome parameters were assessment of suturing quality and workload perception.ResultsA total of 10 novice participants were included and completed a total of 300 sessions. Median (IQR) suturing time of the first 5 sessions was 231 s (188–291) in the laparoscopic group versus 378 s (282–471) in the FlexDex group versus 189 s (160–247) in the DaVinci Si group. The last 5 sessions showed significant reduction of median suturing time of 143 s (120–190), 232 s (180–265) and 172 s (134–199) respectively. Analysis identified that the learning curve for the laparoscopic needle driver and Da Vinci Si was reached in 5 sessions, compared to 8 sessions for the Flexdex. The laparoscopic needle driver and Da Vinci Si showed a significant shorter median suturing time compared to the FlexDex (p = 0.00). The FlexDex quality assessment scores were significantly lower compared to the laparoscopic (p = 0.00) and robotic (p = 0.00) scores and perceived workload remains high for the FlexDex users.ConclusionsEx vivo endoscopic suturing with the FlexDex demonstrated a prolonged learning curve compared to laparoscopic and robotic suturing. The learning curve of the FlexDex is fundamentally different from conventional laparoscopic and robotic instruments. This study provides further insights in the implementation and training of endoscopic suturing techniques.
Highlights
Surgeons have widely adopted endoscopic suturing techniques using conventional laparoscopic instruments and the more advanced robotic systems
The significant costs of robotic surgery remain an important restrictive factor. This financial gap between laparoscopic and robotic instruments has motivated the development of hand held articulating laparoscopic suturing instruments, such as the FlexDex Surgical laparoscopic needle driver (FlexDex, Inc., Brighton, MI), Kymerax (Terumo, Japan) [19] and the Radius Surgical System
This study indicates that manipulation of the FlexDex is different from conventional laparoscopic and robotic systems and requires more training
Summary
Surgeons have widely adopted endoscopic suturing techniques using conventional laparoscopic instruments and the more advanced robotic systems. The significant costs of robotic surgery remain an important restrictive factor This financial gap between laparoscopic and robotic instruments has motivated the development of hand held articulating laparoscopic suturing instruments, such as the FlexDex Surgical laparoscopic needle driver (FlexDex, Inc., Brighton, MI), Kymerax (Terumo, Japan) [19] and the Radius Surgical System Medical GmbH, Germany)[20, 21] These instruments provide the surgeon with some of the dexterity benefits of robotic surgery. The FlexDex is a novel mechanically articulated suturing device (Fig. 1) This arm mounted device is fundamentally different from previous articulating needle holders, since it converts wrist movements into articulation of the tip of the instrument. Use of the FlexDex could improve the ergonomics of the surgeon in comparison with conventional laparoscopic instrumentation
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