Handheld robotic needle holder training: slower but better

Efficacy and Safety of a Novel Handheld Robotic Needle Holder Versus Conventional Instrument in Laparoscopic Ureterolithotomy: A Multicenter, Randomized, Single-Blind, Positive Parallel Controlled, and Noninferiority Clinical Trial

Purpose: This study aimed to validate the efficacy and safety of the HTH-1 handheld robotic needle holder versus conventional instrument in laparoscopic ureterolithotomy. Methods: This is a noninferiority clinical trial conducted in three hospitals. Patients were enrolled and randomly allocated into the experimental or control group on whom laparoscopic ureterolithotomy was performed with the ureteral incision sutured using the HTH-1 and conventional needle holder, respectively. The average suture time per stitch (STPS) of ureter was calculated as the primary efficacy indicator. Postoperative drainage volumes were recorded, and the instruments' operating performance was subjectively evaluated and compared between groups. Adverse events occurred during the trial and interference of the instruments to the monitor were assessed as the safety indicators. Results: From April to September 2018, 50 patients were enrolled with 25 ones in each group. For the efficacy indicators, the noninferiority of the STPS was determined when the noninferiority margin was 40 seconds. The postoperative drainage volumes were not significantly different between groups. The instruments' operating performance was rated as smooth in all cases of both groups. For the safety indicators, no adverse events or interference of the instruments to the monitor occurred during surgery in any case. Clavien 1 complications occurred in 7 (4 in the experimental group versus 3 in the control group, P = 1.000) patients after surgery. Conclusions: The HTH-1 is effective and safe and noninferior to conventional needle holder in laparoscopic ureterolithotomy. Adequate training and skills assessment are needed before application on patients. Clinical trial registration: The clinical trial registration was completed in Jiangsu Provincial Drug Administration (record number: Suxielinbei 20180018).

Construct Validity of a Novel Assessment System for Laparoscopic Suture Accuracy Based on Stereoscopy

BACKGROUND

An accurate and objective measuring tool is lacking for laparoscopic suture accuracy assessment in simulation training. We designed and developed the suture accuracy testing system (SATS) and aimed to determine its construct validity in this study.

METHODS

Twenty laparoscopic experts and 20 novices were recruited to perform a suturing task in three sessions using traditional laparoscopic instruments (Tra. session), a handheld multi-degree-of-freedom (MDoF) laparoscopic instrument (MDoF session) and a surgical robot (Rob. session), respectively. The needle entry and exit errors were calculated using the SATS and compared between the two groups.

RESULTS

No significant difference of the needle entry error was found in all comparisons. As for the needle exit error, the value of the novice group was significantly higher than that of the expert group in Tra. session (3.48 ± 0.61 mm vs. 0.85 ± 0.14 mm; p = 1.451e-11) and MDoF session (2.65 ± 0.41 mm vs. 1.06 ± 0.17 mm; p = 1.451e-11) but not in Rob. session (0.51 ± 0.12 mm vs. 0.45 ± 0.08 mm; p = 0.091).

CONCLUSIONS

The SATS demonstrates construct validity. Surgeons' experience in conventional laparoscopic instruments could be transferred to the MDoF instrument. Surgical robot helps to improve suture accuracy and may bridge the experience gap between laparoscopic experts and novices in basic exercises.

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.