Comparison of surgical performance using articulated (ArtiSential®) and conventional instruments for colorectal laparoscopic surgery: A single-centre, open, before-and-after, prospective study.

Autor: Shin HR; Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea., Oh HK; Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.; Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea., Ahn HM; Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea., Lee TG; Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea., Choi MJ; Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea., Jo MH; Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea., Singhi AN; Department of General Surgery, Saifee Hospital, Mumbai, Maharashtra, India., Kim DW; Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.; Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea., Kang SB; Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.; Department of Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
Jazyk: angličtina
Zdroj: Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland [Colorectal Dis] 2024 Dec; Vol. 26 (12), pp. 2092-2100. Date of Electronic Publication: 2024 Oct 25.
DOI: 10.1111/codi.17205
Abstrakt: Aim: Rigid surgical instruments limit movement whereas articulated instruments offer better control in small spaces and allow for intuitive and ergonomic movements. However, the effectiveness of the use of articulated instruments in improving colorectal laparoscopic outcomes remains unclear. The aim of this work was to determine whether colorectal laparoscopic surgical proficiency improved when multijoint instruments were used instead of conventional ones.
Method: We enrolled 70 consecutive patients (n = 20 for conventional instruments) aged 19-80 years who underwent elective laparoscopic surgery for colorectal diseases. Unedited surgery videos were validated using the modified Global Operative Assessment of Laparoscopic Skills (mGOALS) scale. Learning curves were analysed using a cumulative sum control chart for mGOALS grades.
Results: The surgery type, length of hospital stay and 30-day postoperative complication rates were comparable between the groups, and the surgeon's mGOALS grades were similar (p = 0.190). However, in the articulated group, the scores were significantly higher for depth perception (p = 0.012) and tissue-handling domains (p = 0.046), while surgical duration was significantly shorter and intraoperative blood loss was significantly lower (p = 0.022), compared with those in the conventional (p = 0.002) group. Learning curve findings indicated that the first 10 and subsequent 40 surgeries in the articulated group were within the inexperienced and experienced phases, respectively. The mGOALS score in the experienced phase improved in the articulated group compared with that in the conventional group (p = 0.036).
Conclusions: The use of articulated instruments in laparoscopic colorectal surgery showed potential benefits. Further studies are needed to confirm these findings.
(© 2024 Association of Coloproctology of Great Britain and Ireland.)
Databáze: MEDLINE
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