A randomized comparison of conventional vs articulating laparoscopic needle-drivers for performing standardized suturing tasks by laparoscopy-naive subjects.
ABSTRACT To compare the efficacy of conventional and articulating laparoscopic needle-drivers for performing standardized laparoscopic tasks by medical students with no previous surgical experience.
Twenty medical students with no surgical experience were randomly assigned to two equal groups, one using a conventional laparoscopic needle-holder (Karl Storz, Tuttlingen, Germany) and the other using a first-generation articulating laparoscopic needle-holder (Cambridge Endo, Framingham, MA, USA). Each student performed a series of four standardized laparoscopic tasks, during which speed and accuracy were assessed. The tasks tested needle passage through rings (1), an oblique running suture model (2), a urethrovesical anastomosis model (3) and a model simulating renal parenchymal reconstruction following partial nephrectomy (4).
Tasks 1 and 3 were completed significantly more quickly by those using the conventional instruments (P < 0.05), but there was no statistically significant difference for task 2 and 4 (P > 0.05). Those using conventional instruments were significantly more accurate in all of the tasks than those using the articulated instruments (P < 0.05).
The conventional laparoscopic needle-driver allowed laparoscopy-naive medical students to complete a series of standardized suturing tasks more rapidly and accurately than with the novel articulating needle-driver. Laparoscopic suturing with first-generation articulating needle-drivers might be more difficult to learn, secondary to the complexity of physical manoeuvres required for their use.
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ABSTRACT: Hundreds of laparoendoscopic single-site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES) cases have been reported in the literature across a broad span of urological procedures. Despite this, many hurdles to widespread adoption of these techniques exist, including technical challenges, such as decreased triangulation and unfamiliar viewing angles, and more philosophical issues, such as the necessity of demonstrating benefits of these techniques over conventional laparoscopy. Future research will seek to overcome these obstacles. This may be accomplished with further instrument development, including robotic instrumentation, as well as clinical studies evaluating outcomes of LESS/NOTES operations that may demonstrate advantages in these techniques.BJU International 09/2010; 106(6 Pt B):941-4. · 3.05 Impact Factor
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ABSTRACT: Minimally Invasive Single Site (MISS) surgery is a better terminology to explain the novel concept of scarless surgery, which is increasingly making its way into clinical practice. But, there are some difficulties. We review the existing technologies for MISS surgery with regards to single-port devices, endoscope and camera, instruments, retractors and also the future perspectives for the evolution of MISS surgery. While we need to move ahead cautiously and wait for the development of appropriate technology, we believe that the "Ultimate form of Minimally Invasive Surgery" will be a hybrid form of MISS surgery and Natural Orifice Transluminal Endoscopic Surgery, complimented by technological innovations from the fields of robotics and computer-assisted surgery.Journal of Minimal Access Surgery 01/2011; 7(1):40-51.