Conventional Needle Holder Research Articles

A crossover study on the advantage of an additional rotation function in a needle holder compared to a conventional needle holder in a pelvitrainer model

Background: Needle-loading is the most challenging step in laparoscopic suturing. The rotational needle holder (RNH) is a handheld laparoscopic instrument, which increases the degree of freedom relative to the needle by the rotation of the instrument’s tip. By moving the jaws of the needle holder with a clamped needle a rotational movement is achieved, which allows the needle to be adjusted. The aim of this study was to compare the RNH with the conventional needle holder (CNH) in a pelvitrainer model. Methods: Twenty medical students with no prior laparoscopic experience performed four standardized exercises. The participants were randomly divided into two groups. Group RC performed the suture exercises using the RNH first and the CNH thereafter. Group CR performed these tasks in the reverse sequence. The number of errors, precision, and time taken were measured. After each task, the students had to answer specific questions about the methods used. Results: The 270-degree angle task was performed with significantly fewer mistakes (P=0.003) and more rapidly using the RNH in the second period (P=0.008). The students performed the 180-degree angle task more rapidly during the second run, regardless of which technique was used (P=0.042). Neither of the other two tasks showed any significant difference. The precision was very good overall, and in all four tasks it was superior when the rotational method was used, although no significant difference was observed. The students made more mistakes when using the CNH. The questionnaire confirmed a clear advantage for the RNH, but the participants expressed concerns about its counterintuitive handling. Conclusions: The advantages of the RNH were only partially confirmed. For some angles, the rotational function was beneficial. However, this value was decreased for participants with greater experience and superior laparoscopic skills. More intuitive control of the rotation function may potentially offer an advantage in terms of speed and may be associated with a steeper learning curve.

Handheld laparoscopic robotized instrument: progress or challenge?

Handheld laparoscopic robotized instruments have been developed to combine the advantages of a robotic operation system and conventional laparoscopic instruments. Direct objective standards are needed to quantify surgeons' skill level and validate the advantages of new instruments. This study describes and objectively evaluates the use of a robotized instrument using a force-sensing test platform. The test platform consists of 12 rings on a hypersensitive force sensor. Forty volunteers were recruited: the expert group included 20 laparoscopic experts and the novice group included 20 medical students in their 4th year without laparoscopic skills. The baseline of the two groups was identified using a conventional needle holder. Participants then repeated the test with the robotized needle holder after training. The maximum force and impulse of each ring were analyzed for each group. Institutional review board approval is not needed for this study. Significantly lower maximum force and impulse were observed in the expert group than in the novice group during the baseline test (all P < 0.05). After training, a significant difference remained in maximum force and impulse between the two groups using the robotized needle holder (all P < 0.05). Within each group, there was no difference in maximum force or impulse using the robotized needle holder after training compared to that on using the conventional needle holder (all P > 0.05). The maximum force and impulse recorded by a test platform can accurately identify participants' laparoscopic skill level. Six hours' training can ensure that experts master the use of the robotized needle holder, but this training session is too short for novices to improve their performance with a new instrument. The force-sensing test platform can reflect the suturing characteristics of users based on the skill level and is useful for laparoscopic suture training.

Assessment of Postural Ergonomics and Surgical Performance in Laparoendoscopic Single-Site Surgery Using a Handheld Robotic Device.

New laparoscopic devices are being continuously developed to overcome some of the technical and ergonomic limitations of laparoendoscopic single-site (LESS) surgery. This study aims to assess the surgeon's surgical performance and ergonomics during the use of a handheld, robotic-driven, articulating laparoscopic instrument during LESS surgery. Seven right-handed experienced surgeons took part in this study. A set of basic suturing tasks and digestive and urological procedures in a porcine model were performed. Surgeons used both a conventional laparoscopic needle holder and a robotic device. The learning curve, execution time, and precision using the surgical needle were assessed. The surgeon's posture was analyzed using a motion tracking system and a data glove. After the training period, execution time on the intracorporeal suturing was significantly shorter using the conventional needle holder. The precision was higher using the conventional instrument in the horizontal plane, but the number of attempts to position the needle was lower using the robotic device (1.625 ± 0.250 vs 1.188 ± 0.375 attempts). The extension of the elbow (134.681 ± 14.35° vs 120.631 ± 13.134°) and the flexion of the shoulder (26.122 ± 7.411° vs 18.475 ± 14.166°) were significantly lower using the robotic instrument. The wrist posture using the robotic device was ergonomically acceptable during both surgical procedures. Results show a positive learning curve in ergonomics and surgical performance using the robotic instrument during LESS surgery. This instrument improves the surgeon's body posture and the needle positioning errors. The use of the robotic instrument is feasible and safe during LESS partial nephrectomy and sigmoidectomy procedures.

Initial experience using a robotic-driven laparoscopic needle holder with ergonomic handle: assessment of surgeons' task performance and ergonomics.

The objective of this study is to assess the surgeons' performance and ergonomics during the use of a robotic-driven needle holder in laparoscopic suturing tasks. Six right-handed laparoscopic surgeons with different levels of experience took part in this study. Participants performed a set of three different intracorporeal suturing tasks organized in ten trials during a period of five weeks. Surgeons used both conventional (Conv) and robotic (Rob) laparoscopic needle holders. Precision using the surgical needle, quality of the intracorporeal suturing performance, execution time and leakage pressure for the urethrovesical anastomosis, as well as the ergonomics of the surgeon's hand posture, were analyzed during the first, fifth and last trials. No statistically significant differences in precision and quality of suturing performance were obtained between both groups of instruments. Surgeons required more time using the robotic instrument than using the conventional needle holder to perform the urethrovesical anastomosis, but execution time was significantly reduced after training ([Formula: see text] 0.05). There were no differences in leakage pressure for the anastomoses carried out by both instruments. After training, novice surgeons significantly improved the ergonomics of the wrist ([Formula: see text] 0.05) and index finger (Conv: 36.381[Formula: see text], Rob: 30.389[Formula: see text]; p = 0.024) when using the robotic instrument compared to the conventional needle holder. Results have shown that, although both instruments offer similar technical performance, the robotic-driven instrument results in better ergonomics for the surgeon's hand posture compared to the use of a conventional laparoscopic needle holder in intracorporeal suturing.

Survey on Surgical Instrument Handle Design

Minimally invasive surgical approaches have revolutionized surgical care and considerably improved surgical outcomes. The instrumentation has changed significantly from open to laparoscopic and robotic surgery with various usability and ergonomics qualities. To establish guidelines for future designing of surgical instruments, this study assesses the effects of current surgical approaches and instruments on the surgeon. Furthermore, an analysis of surgeons' preferences with respect to instrument handles was performed to identify the main acceptance criteria. In all, 49 surgeons (24 with robotic surgery experience, 25 without) completed the survey about physical discomfort and working conditions. The respondents evaluated comfort, intuitiveness, precision, and stability of 7 instrument handles. Robotic surgery procedures generally take a longer time than conventional procedures but result in less back, shoulder, and wrist pain; 28% of surgeons complained about finger and neck pain during robotic surgery. Three handles (conventional needle holder, da Vinci wrist, and joystick-like handle) received significantly higher scores for most of the proposed criteria. The handle preference is best explained by a regression model related only to comfort and precision (R(2) = 0.91) and is significantly affected by the surgeon's background (P < .001). Although robotic surgery seems to alleviate physical discomfort during and after surgery, the results of this study show that there is room for improvement in the sitting posture and in the ergonomics of the handles. Comfort and precision have been found to be the most important aspects for the surgeon's choice of an instrument handle. Furthermore, surgeons' professional background should be considered when designing novel surgical instruments.

Needle holder for laparoscopic surgery. Joint mechanisms for the angled shafts.

The motion freedom of conventional needle holder is poor inside of the abdominal wall. To get easy suture work, this paper insists the needle grip jaws should be able to rotate around the bent shaft at the end part of the holder. The shaft size φ10 and the large loads make it difficult to design the angled shaft joint mechanisms. This paper discusses the characteristics of four type of mechanims as ; traditional frexible joint composed with wires wound in three layers, bevel gear mechanism, driven wire that is wound around the jaws shaft, and new frexible joint composed with thin belts wound in layers, Some types of damages of the new belt wind joint are clarified in the relations with the load and the lead angle of the belt.

SURGEON'S HELPER

To the Editor: —Any instrument, particularly a simple and inexpensive one, that aids or expedites a surgical procedure is worthy of note. The surgeon's helper is such an instrument; it might even be called a seeker. This little instrument contains a powerful patented magnet not so large as a conventional needle holder. It is entirely self-contained and has no batteries or connections. It withstands repeated boiling and autoclaving without apparent loss of magnetic power. The instrument consists of a simple cartridge measuring 7 mm. by