Abstract
BackgroundHospitals in low resource settings (LRS) can benefit from modern laparoscopic methodologies. However, cleaning, maintenance and costs requirements play a stronger role while training and technology are less available. Steerable laparoscopic instruments have additional requirements in these settings and need extra identified adaptations in their design. MethodSeveral modular detachability and tip steerability features were applied to the SATA-LRS instrument platform designed specifically for LRS. Ten subjects participated a dis- and reassembly experiment to validate the modularity, and in a steering experiment using a custom made set-up to validate steering. ResultsA new steerable SATA-LRS instrument was developed with the ability to exchange end-effectors through a disassembly of the shafts. Experiments showed an average 34 and 90 s for complete dis- and reassembly, respectively. Participants were able to handle the instrument independently after a single demonstration and 4 rounds of repetitions. Precise tip-target alignment in the box set-up showed a very short learning-curve of 6 repetitions. ConclusionA novel instrument platform with articulating and rotating end-effector was designed for LRS. Within a minute the SATA-LRS can be disassembled to component level for inspection, cleaning, maintenance and repair, and can be autonomously reassembled by novices after a minimal training. The modular buildup is expected to reduce purchasing and repair costs. The instrument has been shown intuitive by use without extensive training.
Highlights
Laparoscopic surgery has several benefits for LowResource Settings (LRS)
The adoption of steerability in laparoscopic instruments has so-far shown repercussions that hit hard on low resource settings (LRS) where re-use of instruments is largely the norm, training is more difficult, and repair and maintenance is unsupported in terms of local production and human resources [14]
As discussed in the work of Anderson et al [3], there is no apparent consensus on the specific DOFs a steerable instrument should have
Summary
Laparoscopic surgery has several benefits for LowResource Settings (LRS). One of the main focus points in laparoscopic instrument design has been on the steerability of instrument’s end-effector where tip-tissue alignment is supported with additional DOFs at the end-effector. Many designs for steer able laparoscopic instruments require compromises, being that they become difficult or unintuitive to use, have thicker shafts requiring bigger incisions, and are generally too complex for cleaning or mainte nance which make them single use [3] while purchasing costs are mostly higher. For LRS, the design of steerable laparoscopic instruments requires development with a higher focus on cost-suppressing reusability, meaning cleaning and. Method: Several modular detachability and tip steerability features were applied to the SATA-LRS instrument platform designed for LRS. The instrument has been shown intuitive by use without extensive training
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