Authors: Tobias Göpel Felix Härtl Armin Schneider Martin Buss Hubertus Feussner
Publish Date: 2011/02/07
Volume: 25, Issue: 7, Pages: 2100-2104
Abstract
In minimally invasive surgery hand suturing is categorized as a challenge in technique as well as in its duration This calls for an easily manageable tool permitting an allpurpose costefficient and secure viscerosynthesis Such a tool for this field already exists the Autosuture EndoStitch® In a series of studies the potential for the EndoStitch to accelerate suturing has been proven However its ergonomics still limits its applicability The goal of this study was twofold propose an optimized and partially automated EndoStitch and compare the conventional EndoStitch to the optimized and partially automated EndoStitch with respect to the speed and precision of suturingBased on the EndoStitch a partially automated suturing tool has been developed With the aid of a DC motor triggered by a button one can suture by onefingered handling Using the partially automated suturing manipulator 20 surgeons with different levels of laparoscopic experience successfully completed a continuous suture with 10 stitches using the conventional and the partially automated suture manipulator Before that each participant was given 1 min of instruction and 1 min for training Absolute suturing time and stitch accuracy were measured The quality of the automated EndoStitch with respect to manipulation was tested with the aid of a standardized questionnaireTo compare the two instruments t tests were used for suturing accuracy and time Of the 20 surgeons with laparoscopic experience fewer than 5 laparoscopic interventions n = 9 fewer than 20 laparoscopic interventions n = 7 more than 20 laparoscopic interventions n = 4 there was no significant difference between the two tested systems with respect to stitching accuracy However the suturing time was significantly shorter with the Autostitch P = 001 The difference in accuracy and speed was not statistically significant considering the laparoscopic experience of the surgeons The weight and size of the Autostitch have been criticized as well as its cable However the comfortable handhold automatic needle change and ergonomic manipulation have been rated positivePartially automated suturing in minimally invasive surgery offers advantages with respect to the speed of operation and ergonomics Ongoing work in this field has to concentrate on minimization implementation in robotic systems and development of new operation methods NOTES
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