Evaluation of new motorized articulating laparoscopic instruments by laparoscopic novices using a standardized laparosco
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and Other Interventional Techniques
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Evaluation of new motorized articulating laparoscopic instruments by laparoscopic novices using a standardized laparoscopic skills curriculum Daniel Uysal1 · Claudia Gasch2 · Rouven Behnisch3 · Felix Nickel4 · Beat Peter Müller‑Stich4 · Markus Hohenfellner2 · Dogu Teber2,5 Received: 10 June 2020 / Accepted: 3 October 2020 © The Author(s) 2020
Abstract Background Motorized articulating laparoscopic instruments (ALI) offer more degrees of freedom than conventional laparoscopic instruments (CLI). However, a difficult learning curve and complex instrument handling are still a problem of ALI. We compared the performance of new prototypes of motorized ALI with CLI in a series of standardized laparoscopic tasks performed by laparoscopic novices. Further, usability of the new ALI was assessed. Methods A randomized cross-over study with 50 laparoscopic novices who either started with CLI and then changed to ALI (CA) or vice versa (AC) was conducted. All participants performed the European training in basic laparoscopic urological skills (E-BLUS) with each instrument in given order. Time and errors were measured for each exercise. Instrument usability was assessed. Results Overall, using CLI was significantly faster (CLI 4:27 min vs. ALI 4:50 min; p-value 0.005) and associated with fewer exercise failures in needle guidance (CLI 0 vs. ALI 12; p-value 0.0005) than ALI. Median amount of errors was similar for both instruments. Instrument sequence did not matter, as CA and AC showed comparable completion times. Regarding the learning effect, participants were significantly faster in the second attempt of exercises than in the first. In the needle guidance task, participants using CLI last demonstrated a significant speed improvement, whereas ALI were significantly slower in the second run. Regarding usability, CLI were preferred over ALI due to lighter weight and easier handling. Nevertheless, participants valued ALI’s additional degrees of freedom. Conclusion Using new motorized ALI in the E-BLUS examination by laparoscopic novices led to a worse performance compared to CLI. An explanation could be that participants felt overwhelmed by ALI and that ALI have an own distinct learning curve. As participants valued ALI’s additional degrees of freedom, however, a future application of ALI could be for training purposes, ideally in combination with CLI. Keywords Motorized articulating laparoscopic instruments · Handheld robotic device · Laparoscopy · E-BLUS · Urology · Training Abbreviations ALI Articulating laparoscopic instrument(s) CC E-BLUS exercise “cutting a circle” Daniel Uysal and Claudia Gasch both authors share first authorship. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00464-020-08086-2) contains supplementary material, which is available to authorized users. * Claudia Gasch [email protected]‑heidelberg.de Extended author information available on the last page of the article
CLI Conventional laparosc
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