Invited commentary: Comparison of visual discomfort experienced by surgeons in wireless versus conventional endoscopy in laparoscopic surgery.

Abstract

In this study titled “A comparison of visual discomfort experienced by surgeons in wireless versus conventional endoscopy in laparoscopic surgery,” Xu et al. present a novel fifth-generation transmission wireless endoscopic system. They evaluated the visual discomfort in a small cohort of single-institution surgeons (n = 20) and compared its degree between conventional and wireless endoscopic laparoscopic surgeries (laparoscopic radical prostatectomy and laparoscopic radical cystectomy). Subjective questionnaires and objective physiological indicators were used to assess this outcome. They found no difference in visual discomfort between these technologies. For decades, the development of new medical and surgical devices has enabled the rise of state-of-the-art minimally invasive surgeries and enhanced the treatment efficiency of diseases. New technologies have affected every aspect of patient care. The introduction of laparoscopic, robotic, and endoscopic surgery in the urological field has allowed surgeons to push treatment boundaries and perform more challenging procedures in a less invasive manner. However, the “minimally invasive” laparoscopic approach is associated with greater perceived discomfort and musculoskeletal pain. [1] Notwithstanding the surgeons' burden associated with the laparoscopic surgery approach, [2] the technique is currently preferred over the open surgery technique for most cases, as it is associated with less pain, less bleeding, and shorter recovery time for patients. [3] In recent years, surgeons' ergonomic awareness has increased. Factors such as exposure and visualization, surgical instrumentation, and posture are key to avoiding musculoskeletal pain and long-term injury. [4] Thus, ergonomic integration and an appropriate operating room environment are paramount to ensure surgical efficiency, safety, and surgeon comfort. [5] The wireless innovative surgical device presented in the study may be comparable to the wired instrument in terms of visual discomfort; however, it may provide other essential benefits such as reduced physical exertion during surgery. Removing the camera wire from the surgical field confers a clear advantage in creating a clean and tidy terrain. The use of wireless devices in the operating room may aid in creating a better environment and improve surgeon ergonomics, ultimately translating into better procedures and outcomes. However, conclusions must be drawn with caution when introducing innovative technologies into the surgical setting. It is not possible to accept a technology of less-than-current standard. The benefits of the proposed instrument must outweigh its limitations to be validated and to eventually expand and change practice. This study did not measure crucial variables such as procedure duration, intraoperative complications, and surgical outcomes. The instrument's weight, battery autonomy, and grasp ergonomy are other important aspects that should be considered. Furthermore, the cost of the wireless device should meet the intersection between the need for improvement and availability of resources in the healthcare system. Today, the dramatic acceleration in the development of surgical instrument technology creates a unique need to rapidly adapt to the latest devices to stay at the forefront and continue moving forward in the field. However, such technologies require validation, and studies must collaborate to build the body of evidence necessary to shift from current practices toward new approaches.