Laparoscopic Needle Research Articles

Effectiveness of an articulating laparoscopic needle holder for cesarean scar defect repair.

To evaluate the efficacy of an articulating laparoscopic needle holder in laparoscopic surgery for cesarean scar defect. We performed a retrospective case-control study at the Shiga University of Medical Science. Patients who underwent laparoscopic uterine scar repair were divided into an articulating laparoscopic needle holder (ArtiSential®) group and a rigid needle holder (conventional) group to compare the suture and total operative times. Uterine myometrial suturing involves a double-layer interrupted suture, including a modified Gambee suture for the first layer. We measured the residual myometrial thickness using magnetic resonance imaging preoperatively and at 3 months postoperatively. Both groups comprised 10 patients each. The time per stitch for the first and second layers was significantly shorter in the ArtiSential group than in the conventional group (median 208 s vs. 403 s, p < 0.0001 and median 17 s vs. 29 s; p < 0.0001, respectively). The total operating time was significantly shorter in the ArtiSential group (mean 188 min vs. 240 min, p = 0.0015). The postoperative residual myometrial thickness (mean 9.1 mm in the ArtiSential group and 9.6 mm in the conventional group) was significantly higher than the preoperative residual myometrial thickness (mean 1.6 mm in the ArtiSential group and 1.6 mm in the conventional group) (p < 0.0001 in both groups). An articulating needle holder is useful in laparoscopic surgery for cesarean scar defect, especially when a modified Gambee suture is required.

A prospective study to assess the feasibility of single port laparoscopic needle assisted repair of pediatric inguinal hernias

Background: Congenital inguinal hernias are very common paediatric surgical conditions with incidence of 0.8 – 4.4% in children and up to 30% in preterm babies, which occur due to the failure of closure of the processus vaginalis. While the gold standard treatment remains to be open herniotomy, in the last two decades minimally invasive surgeries have revolutionized the hernia surgery and have evolved from 3 port to single port, intracorporeal knotting to extracorporeal knotting and 5 mm camera port to 3 mm camera port with multiple benefits. Methodology: This is a prospective study conducted at a single tertiary care centre over 1 year. All the patients admitted under the Department of Paediatric Surgery, with a clinical and/or radiological diagnosis of inguinal hernia and planned for single port laparoscopic needle assisted repair were included in the study. Data was collected in terms of intra operative finding, duration of procedure, complications, pain and post operative hospital stay. Results: A total of 40 patients were included in the study with a male predominance. Clinically majority were right inguinal hernia which was reducible. Intraoperatively, 7 cases of bilateral hernia were identified which were not detected pre operatively. 2 patients who underwent this procedure had complications and majority of the patients had mild pain. Conclusion: Single port laparoscopic herniotomy is at par with gold standard open herniotomy in the paediatric population. This procedure has better cosmesis, lesser post operative pain, hospital stay and most importantly it could identify occult hernias.

Expedited Laparoscopic Cholangiogram and Liver Biopsy in the Workup of Biliary Atresia.

Recent studies demonstrate the success of Kasai portoenterostomy for biliary atresia (BA) is linearly related to infant age at time of Kasai. We sought to review the feasibility and safety of laparoscopic needle micropuncture cholangiogram with concurrent core liver biopsy (if needed) for expedited exclusion of BA in patients with direct conjugated hyperbilirubinemia. Expedited laparoscopic cholangiogram and liver biopsy were instituted at our facility for infants with direct hyperbilirubinemia for whom clinical exam and laboratory workup failed to diagnose. A retrospective chart review was performed in infants <1 year with hyperbilirubinemia from 2016 to 2021. Demographics, preoperative evaluation, procedure details, and complications were reviewed. Two hundred ninety-seven infants with unspecified jaundice were identified, of which, 86 (29%) required liver biopsy. Forty-seven percutaneous liver biopsies were obtained including 8 (17%) in whom BA could not be excluded. Laparoscopic cholangiogram was attempted in 47 infants following basic workup; BA was diagnosed in 22 infants (47%) of which 3 were <18 days old. Biliary patency was demonstrated laparoscopically in 22 of 25 (88%); 3 (12%) required conversion to open cholangiogram. Infants with percutaneous liver biopsy had an average delay of 3 days (range: 2-36) to cholangiogram. Preoperative studies and liver biopsy alone did not reliably exclude the diagnosis of BA. Laparoscopic cholangiogram with liver biopsy is a safe procedure resulting in the confirmation or exclusion of BA in infants. Forty-seven percent of infants who underwent laparoscopic cholangiogram were found to have BA; those who were surgical candidates underwent Kasai during the same operation.

Objective psychomotor laparoscopic skills evaluation using a low-cost wearable device based on accelerometry: construct and concurrent validity study.

Motion analysis of surgical maneuvers provides useful quantitative information for the objective evaluation of the surgeons. However, surgical simulation laboratories for laparoscopic training do not usually integrate devices that help quantify the level of skills of the surgeons due to their limited resources and the high costs of new technologies. The purpose of this study is to present the construct and concurrent validity of a low-cost motion tracking system, based on a wireless triaxial accelerometer, employed to objectively evaluate psychomotor skills of surgeons during laparoscopic training. An accelerometry system, a wireless three-axis accelerometer with appearance of wristwatch, was placed on the dominant hand of the surgeons to register the motion during the laparoscopy practice with the EndoViS simulator, which simultaneously recorded the motion of the laparoscopic needle driver. This study included the participation of 30 surgeons (6 experts, 14 intermediates and 10 novices) who performed the task of intracorporeal knot-tying suture. Using 11 motion analysis parameters (MAPs), the performance of each participant was assessed. Subsequently, the scores of the three groups of surgeons were statistically analyzed. In addition, a validity study was conducted comparing the metrics between the accelerometry-tracking system and the EndoViS hybrid simulator. Construct validity was achieved for 8 of the 11 metrics examined with the accelerometry system. Concurrent validity demonstrated that there is a strong correlation between the results of the accelerometry system and the EndoViS simulator in 9 of 11 parameters, showing reliability of the accelerometry system as an objective evaluation method. The accelerometry system was successfully validated. This method is potentially useful to complement the objective evaluation of surgeons during laparoscopic practice in training environments such as box-trainers and simulators.

Laparoscopic Retrieval of a Retained Foreign Body Embedded in the Retroperitoneum

A 38-year-old nulliparous woman without surgical history with enlarging uterine fibroids underwent laparoscopic myomectomy. A routine abdominal X-ray performed on postoperative day 2 showed a foreign body in the pelvis. Computed tomography revealed a metallic object, which was located outside the bowel. A planned laparoscopic exploration was undertaken on postoperative day 42. The foreign body was difficult to find, but unidimensional fluoroscopy revealed that it was embedded in the retroperitoneum. Local angiogenesis of the peritoneum, which rose on the right uterosacral ligament (USL), was noted in its location (Fig. 1). Laparoscopic retrieval of the foreign body was performed, along with an excision of surrounding connective tissue under the USL (Fig. 2), and it was confirmed that a 4 × 2 × 1 mm metallic object was removed (Fig. 3A). The object was confirmed to be a broken part of laparoscopic needle holder (Fig. 3B) which had been subsequently used in other surgeries following the index procedure. Fig. 2Laparoscopic image. The foreign body was retrieved by excising surrounding connective tissue en bloc. View Large Image Figure Viewer Download Hi-res image Fig. 3(A) A removed metallic object measuring 4 × 2 × 1 mm in size. (B) The jaw of laparoscopic needle holder. The object was confirmed to be a broken part (red arrow) of needle holder. View Large Image Figure Viewer Download Hi-res image

Intraoperative breakage of a laparoscopic needle holder confirmed by postoperative abdominal X-ray: A case report and literature review

Introduction: Intraperitoneal retention of surgical instrument fragments may lead to severe complications. Therefore, such foreign bodies must be detected before surgery completion. We present a case with intraoperative breakage of a laparoscopic needle holder confirmed by a routine postoperative abdominal X-ray and review the literature regarding intraoperative laparoscopic instrument breakage. Case Report: A 58-year-old woman with stage IB1 cervical adenocarcinoma underwent a laparoscopic radical hysterectomy. Surgery was completed without major complications; however, an abdominal X-ray as a routine postoperative examination revealed a radiopaque shadow of approximately 3 mm corresponding to a broken part of the tissue-pad of the laparoscopic needle holder tip. It was successfully removed using laparoscopy with fluoroscopic guidance without further complications. According to the literature review, most of the instrument breakage were noticed during surgery as they were either obvious or impaired function. In our case, since the detached foreign body was extremely small and did not significantly affect needle holder function, it remained unnoticed until the postoperative X-ray was taken. Conclusion: Postoperative abdominal X-rays identify instrumental fragments infrequently; however, they may help detect intraperitoneal retention of foreign bodies and avoid serious complications following laparoscopic surgery.

Description of the technique for laparoscopic radical prostatectomy in canine cadavers: 2D vs. 3D camera.

To describe the technique of laparoscopic radical prostatectomy in canine cadavers. Cadaveric study. 8 canine cadavers. Specimens were randomly divided into a 2D or 3D group. The vesicourethral anastomosis (VUA) was performed with 5 mm laparoscopic needle holders. A unidirectional barbed suture was used to complete the VUA with two simple continuous suture patterns. The number of stitches placed, the patency of the anastomosis, and the distance between the VUA and the ureters were recorded. Four dogs were entered into each group. The prostatectomy was completed in each dog following the same technique. VUA were completed with nine stitches (range: 8-10 stitches) for the 2D group and ten stitches (range: 9-11 stitches) for the 3D group (p<0.176). All the stitches were placed full thickness. The VUA was patent in each case. The left ureter was 1.05 cm (range: 0.5 to 1.1cm) from the VUA in the 2D group and 1.8 cm (range: 1.3-1.8 cm) for the 3D group (p< 0.025). The right ureter was 1.5 cm (range: 1 to 2 cm) from the VUA in the 2D group and 1.75 cm (range: 1.3-2 cm) for the 3D group (p< 0.55). Laparoscopic radical prostatectomy can be performed with a 2D or a 3D camera in canine cadavers. The 3D camera results in more accurate placement of the sutures since they were placed further away from the left ureter. Radical prostatectomy with laparoscopy should be considered for dogs.

Evaluation of laparoscopic skills in medical students.

To evaluate the laparoscopic skills of medical students and identify personal characteristics in terms of greater easiness in performing laparoscopic surgical procedures. This study included medical students in the 6th semester of a Medical School in Brazil who answered 10 questions concerning their habits and characteristics. A laparoscopic platform and an abdominal synthetic model were used to assess surgical skills comprising the three following surgical steps: to pass the needle through the trocar and to place it in the laparoscopic needle holder, to perform a laparoscopic simple stitch in synthetic liver parenchyma and, to perform a laparoscopic surgical knot. The duration of the activity was limited to four minutes and the procedure was monitored by a laparoscopic surgeon. The study included 50 students. Of these, 18% completed the three surgical stages. Steps 1 and 2 were completed by 94% and 88% of students, respectively. No statistically significant variables were found when characteristics of the groups with and without success in the three stages were compared. The group that finished the activity had a faster time completing step 2 than the group that failed (mean time of 115.3 seconds against 157.8 seconds, p=0.03). The minority of students could complete effectively all three surgical steps. No personal traits related to greater surgical skill were identified.

8549 Simplifying Laparoscopic Suturing for the Gynecologic Trainee: A Systematic Approach for Reproducible Needle Handling

<h3>Study Objective</h3> Laparoscopic suturing and needle handling are core components of gynecologic surgical management of many benign and malignant disease processes. Adoption of a reproducible technique for laparoscopic needle loading and handling is beneficial for the gynecologic trainee. <h3>Design</h3> Educational demonstration of a surgical technique. <h3>Setting</h3> The demonstration of this method is shown in a laparoscopic simulator trainer with a vaginal cuff model. <h3>Patients or Participants</h3> N/A. <h3>Interventions</h3> This video demonstrates a 3-step approach for safe and efficient needling loading and handling in a simulation environment. 1. Grasp the suture one to two centimeters from the swaged end of the needle to serve as the fulcrum of movement. 2. Lightly grasp the body of the needle so it may act as a pendulum for the swing. 3. Maintain tension on the suture to allow for needle rotation. <h3>Measurements and Main Results</h3> N/A <h3>Conclusion</h3> Mastering laparoscopic needle handling and suturing are important fundamentals of gynecologic laparoscopic surgery. The swing technique may be used in a variety of port configurations making it adaptable and transferable across a wide setting of operations. Additionally, it uses minimal needle grasps for increased safety and efficiency. Learning this reproducible and methodical swing technique may help develop safe and efficient needle handling practices for the gynecologic trainee.

422 Assessment of an Articulating Laparoscopic Needle Holder (FlexDex™) Compared to a Conventional Rigid Needle Holder in 2-Dimension Vision Amongst Novices: A Randomised Controlled Study

Abstract Aim This study aims to compare novice performance of advanced bimanual laparoscopic skills using an articulating laparoscopic device (FlexDex™) compared to a standard rigid needle holder amongst surgical novices in 2-dimension (2D) visualisation. Method In this prospective randomised trial, novices (n=40) without laparoscopic experience were recruited and randomised into two groups, which used either traditional rigid needle holders or the FlexDex™. Both groups performed 10 repetitions of a validated assessment task. Times taken and error rates were recorded, and results were evaluated based on completion times, error rates, and learning curves. Results The intervention group that used the FlexDex™ completed 10 attempts of the standardised laparoscopic task slower than the control group that used traditional rigid needle holder (415 seconds vs 267 seconds taken for the first three attempts and 283 seconds vs 187 seconds taken for the last three attempts, respectively). The difference in average time for the first three and last three attempts reached statistical significance (P &amp;lt; 0.001). Furthermore, the intervention group demonstrated a higher error rate when compared to the control group (9.2 vs 6.3 errors per individual). Conclusions When compared to the FlexDex™, the traditional rigid needle holder was observed to be superior in task performance speed, leading to shorter completion times and quicker learning effect, as well as fewer errors.

409 Evaluation of Advanced Bimanual Skills in Novices Using the Wrist-Like FlexDex™ Articulating Laparoscopic Needle Holder in 2D and 3D Vision: A Randomised Trial

Abstract Aim The aim of this study was to evaluate the novice performance of advanced bimanual laparoscopic skills using the articulating FlexDex™ laparoscopic needle holder in two-dimensional (2D) and three-dimensional (3D) visual systems. Method In this prospective randomised trial, novices (n=40) without laparoscopic experience were recruited from a university cohort and randomised into two groups, which used the FlexDex™ and 2D or the FlexDex™ and 3D. Both groups performed 10 repetitions of a validated assessment task. Times taken and error rates were measured, and assessments were made based on completion times, error rates and learning curves. Results The intervention group that used FlexDex™ and 3D visual output completed 10 attempts of the standardised laparoscopic task quicker than the control group that used FlexDex™ with standard 2D visual output (268 seconds vs 415 seconds taken for the first three attempts and 176 seconds vs 283 seconds taken for the last three attempts, respectively). Moreover, each attempt was completed faster by the intervention group compared to the control group. The difference in average time for the first three and last three attempts reached statistical significance (P &amp;lt; 0.001). Conclusion Combination of 3D visual systems and the FlexDex™ laparoscopic needle holder resulted in superior task performance speed, leading to shorter completion times and quicker learning effect. Although the 3D group demonstrated lower mean error rates, it did not reach statistical significance.

How we acquire suturing skills for laparoscopic hepaticojejunostomy

Laparoscopic choledochal cyst excision and hepaticojejunostomy is a representative surgical procedure requiring laparoscopic suturing including needle driving and knot tying. Laparoscopic needle driving and knot tying is a highly technically demanding skill, especially in small infants and children. We developed a laparoscopic hepaticojejunostomy simulator for training. This simulator was developed for a 1-year-old infant body size based on computed tomography data and reproduced a pneumoperitoneum condition based on 3D scanner data of the clinical situation. Surgeon in training (SITs) of our institution have to acquire practice of laparoscopic hepaticojejunostomy using a simulator before performing clinical cases. Thirteen cases of choledochal cyst have been managed at our institution since the introduction of practice using this simulator in 2016. Six SITs performed 13 cases of laparoscopic choledochal cyst excision and hepaticojejunostomy. There were no cases of anastomotic bile leakage. Laparoscopic disease-specific simulator practice is effective for the acquisition of secure hepaticojejunostomy skills for the treatment of choledochal cysts in children as off-the-job training.

Can a Fully Articulating Electromechanical Laparoscopic Needle Driver Compare with a Robotic Platform in Transabdominal Preperitoneal Inguinal Hernia Repair?

Background: Enhanced laparoscopic instruments are filling the gap between straight-stick laparoscopic equipment and robotic platforms. We sought to evaluate the performance and cost of the HandX™ device during mesh fixation and peritoneal flap closure of transabdominal preperitoneal (TAPP) inguinal hernia repairs. Methods: The video recordings of a consecutive series of TAPP surgeries using the articulated needle driver device were compared with a series of surgeries on the DaVinci robotic platform by a single surgeon. Two critical steps of the procedure were analyzed: mesh fixation and peritoneal closure. A cost analysis between the two platforms was completed. Results: We analyzed 27 cases using the new needle driver and 27 cases using the DaVinci Surgical Robotic system. To evaluate the learning curve (LC) with the HandX device, we created three groups (G1, G2, and G3). The two latter groups were combined and called after LC. Mean fixation time using the DaVinci system was 258.1 seconds (±100.4) compared with 391.5 (±95.9) using the articulating handheld laparoscopic needle driver after LC (P < .001). The average time for peritoneal closure was 418.6 (±192.1) seconds for DaVinci and 634.5 (±159.5) seconds for HandX (P < .001). When comparing the after-LC HandX cases and the DaVinci system stratified by side, there was no significant difference in peritoneal closure in the right side (520.1 seconds (84.3) with the HandX versus 444.2 seconds (229.7) using the DaVinci system (P = .353). When evaluating direct cost of the instruments, HandX cases had a lower cost (310 USD) when compared with the cost of using DaVinci (973 USD). Conclusions: The new smart articulating needle driver may be a cost-effective means of bringing some of the benefits of the robotic platform to laparoscopy.

Single-site laparoscopic high ligation of the extraperitoneal hernia sac with an epidural needle for incarcerated ovarian hernia in infants

BackgroundThe purpose of this study was to evaluate the safety and efficacy of single-site laparoscopic extraperitoneal hernia sac ligation with an epidural needle for incarcerated ovarian hernias in infants and young children.MethodsThe clinical data of 38 infants with incarcerated ovarian hernias who underwent single-site laparoscopic extradural needle extraperitoneal hernia sac ligation from January 2015 to January 2018 were retrospectively analysed.ResultsAll procedures were successfully performed using laparoscopy with no need for conversion to open surgery. The time of hospital stay was 1.30 ± 0.39 days. During hospitalization and follow-up, there were no complications, such as intestinal or bladder injury, abdominal wall vascular injury, ovarian atrophy, hernia recurrence or contralateral indirect hernia. However, three patients experienced complications, including two cases of poor healing of the umbilical incision and one case of suture granuloma.ConclusionsSingle-site laparoscopic high ligation of the extraperitoneal hernia sac with an epidural needle is a safe and feasible method for the treatment of incarcerated ovarian hernias in infants and young children. It has the advantages of minimal trauma, no scarring and good cosmetic effects.

Endoscopic surgery suturing techniques: a randomized study on learning

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.

Laparoscopic Repair of Morgagni Hernia in Children.

Background: This study aims to review laparoscopic repair techniques of Morgagni hernias at a tertiary referral center. Methods: This retrospective study includes pediatric patients who underwent laparoscopic repair of Morgagni hernia between March 2004 and March 2021. The patients' demographics, presenting symptoms, operative approach, and postoperative outcomes were recorded. Results: Fourteen patients underwent laparoscopic repair of Morgagni hernia. The mean age at the time of operation was 24.7 months. Defect closing techniques were intracorporeal knot tying (n: 2), extracorporeal knot tying, and subcutaneous knot placement (n: 10), combination with intracorporeal continuous suturing and several extracorporeal intermittent sutures (n: 2). Different approaches were used during removal of the needle from the insertion point in the extracorporeal knot tying: intracorporeally, using a laparoscopic needle holder (n: 6), with an 18-gauge injector tip (n: 1), and extracorporeally with suture passer forceps (n: 3). In the intracorporeal knot tying technique, the mean operation time was 127 minutes (range 90-180 minutes). In the extracorporeal knot tying technique, the mean operation time was 75 minutes (range 30-180 minutes). The mean operation time in the technique that used suture passer forceps for removing the needle from the same point of insertion was 40 minutes. There was no intraoperative complication. Conclusions: In the laparoscopic repair of Morgagni hernia, full-thickness anterior abdominal wall repair with interrupted sutures that are tied extracorporeally in the subcutaneous tissue by separated minor skin incisions is the easy approach. Using suture passer forceps during removal of the needle facilitates this technique and shortens the operation time.

Assessment of an Articulating Laparoscopic Needle Holder (FlexDex™) Compared to a Conventional Rigid Needle Holder in 2-Dimension Vision Amongst Novices: A Randomised Controlled Study.

AimThis study aims to compare novice performance of advanced bimanual laparoscopic skills using an articulating laparoscopic device (FlexDex™) compared to a standard rigid needle holder amongst surgical novices in 2-dimension (2D) visualisation.MethodsIn this prospective randomised trial, novices (n = 40) without laparoscopic experience were recruited and randomised into two groups, which used either traditional rigid needle holders or the FlexDex™. Both groups performed 10 repetitions of a validated assessment task. Times taken and error rates were recorded, and results were evaluated based on completion times, error rates, and learning curves.ResultsThe intervention group that used the FlexDex™ completed 10 attempts of the standardised laparoscopic task slower than the control group that used traditional rigid needle holder (415 s versus 267 s taken for the first three attempts and 283 s versus 187 s taken for the last three attempts, respectively). The difference in average time for the first three and last three attempts reached statistical significance (P < 0.001). Furthermore, the intervention group demonstrated a higher error rate when compared to the control group (9.3 versus 6.2 errors per individual).ConclusionWhen compared to the FlexDex™, the traditional rigid needle holder was observed to be superior in task performance speed, leading to shorter completion times and quicker learning effect, as well as fewer errors.Key StatementTraditional rigid needle holder leads to faster task completion times and lower error rates when compared with an articulating laparoscopic needle holder in 2D vision.

Evaluation of Advanced Bimanual Skills in Novices Using the Wrist-Like FlexDex™ Articulating Laparoscopic Needle Holder in 2D and 3D Vision: A Randomised Trial

AimThe aim of this study was to evaluate the novice performance of advanced bimanual laparoscopic skills using the articulating FlexDexTM laparoscopic needle holder in two-dimensional (2D) and three-dimensional (3D) visual systems.MethodsIn this prospective randomised trial, novices (n=40) without laparoscopic experience were recruited from a university cohort and randomised into two groups, which used the FlexDexTM and 2D or the FlexDex™ and 3D. Both groups performed 10 repetitions of a validated assessment task. Times taken and error rates were measured, and assessments were made based on completion times, error rates and learning curves.ResultsThe intervention group that used FlexDexTM and 3D visual output completed 10 attempts of the standardised laparoscopic task quicker than the control group that used FlexDexTM with standard 2D visual output (268 seconds vs 415 seconds taken for the first three attempts and 176 seconds vs 283 seconds taken for the last three attempts, respectively). Moreover, each attempt was completed faster by the intervention group compared to the control group. The difference in average time for the first three and last three attempts reached statistical significance (P < 0.001).ConclusionCombination of 3D visual systems and the FlexDexTM laparoscopic needle holder resulted in superior task performance speed, leading to shorter completion times and quicker learning effect. Although the 3D group demonstrated lower mean error rates, it did not reach statistical significance.Key Statement3D visual systems lead to faster task completion times when combined with an articulating laparoscopic needle holder compared to 2D vision. This effect however is not seen in error rates.

Techniques to improve the limited degree of freedom inherent from laparoscopic surgery during laparoscopic duct-to-mucosa pancreaticojejunostomy

Although an increasing number of reports have shown favorable outcomes of laparoscopic pancreaticoduodenectomy (LPD), the penetration rate of LPD is still low due to concerns about complex procedure. Particularly laparoscopic pancreatojejunostomy (PJ) is a highly technical demanding procedure due to reduced degree of freedom inherent to laparoscopic instruments. Here we describe our technique for overcoming technical difficulties of laparoscopic PJ. Six trocars are placed: four trocars on both sides of the upper abdomen in a curvilinear shape with the infra-umbilical trocar in the center and one 12-mm trocar in the epigastrium. The operator stands between both legs of the patient and the laparoscopic camera is introduced through the right lower trocar. We perform a two-layer, duct-to-mucosa PJ in an end-to-side fashion. For the outer layer anastomosis between the pancreas parenchyma and jejunum, the left lower trocar which is in alignment with the pancreatic transection line is used for the needle to be placed perpendicular to the anastomosis line. For the duct-to-mucosa anastomosis, three trocars (left lower, left upper, umbilical) is alternatively used to make various angles of suture. This technique increses the degree of freedom of the straight laparoscopic needle holder when only one trocar is used for duct-to-mucosa anastomosis. The trocar position perpendicular to the anastomosis line and alternatve use of multiple trocars is useful to encompass the 360-degree anastomosis for laparoscopic duct-to-mucosa PJ.

Comparison of leakage pressures of vesicourethral anastomosis performed with intracorporeal suturing in a simulator and conventional suturing ex vivo in canine cadaveric tissue.

To compare conventional and intracorporeal vesicourethral anastomosis (VUA) in canine cadaveric tissue. Cadaveric ex vivo study. Twenty-eight canine bladders with urethra. Specimens after prostatectomy were randomly divided into intracorporeal (I) group or conventional (C) group. For the I group, VUA was performed in a simulator with laparoscopic needle holders and telescope. For the C group, the anastomosis was performed in vitro with standard instruments. The VUA was performed with 4-0 monofilament absorbable suture and was completed with two simple continuous sutures. Surgical time, leakage pressure, site of leakage, and number of suture bites were recorded. Fourteen samples were entered in each group. The dorsal side of the anastomosis was initially performed, followed by the ventral side. The median suturing time was 30.8 minutes (range, 19.3-39.2) for the I group and 17.3 minutes (range, 9.2-21.3) for the C group (P < .0001). The median leakage pressure was 10.9 mm Hg (range, 4.1-29.7) for the I group and 10.8 mm Hg (range, 6.2-18.5) for the C group (P=.94). The median number of stitches was 20 (range, 14-26) for the I group and 19 (range, 11-28) for the C group (P=.96). The distribution of the site of leakage was similar between groups (P=.381). Vesicourethral anastomosis can be performed with leakage pressures similar to intracorporeal and conventional suturing. This study represents the first step toward laparoscopic radical prostatectomy in dogs.