Evaluation and comparison of basic gestures in ex vivo laparoscopic surgery using a robotic instrument and traditional laparoscopic instruments

Summary Background The robotic Dexterite Surgical™ arm (DEX) is an instrument used in laparoscopy that provides 6 degrees of freedom and 360 degrees of rotation with a needle holder and scissors. To evaluate the benefits this instrument offers, we asked novice surgeons to use DEX and a conventional laparoscopic instrument on a pelvitrainer and compared the results. Methods The participants were asked to perform two exercises with DEX and then with a conventional laparoscopic instrument on a pelvitrainer that contained a synthetic reproduction of a male pelvis. For the stitching exercise, the distance from the marked points and any tears caused were analyzed. For the cutting, the participants were judged by how well they respected the marked extremities, the form and the amount of “hacking” observed on a multi-criteria scale. The amount of time required to carry out the exercises was recorded. Results All twelve urology interns all succeeded in using DEX. Of the 36 stitches, seven were giving a failing grade (19.4%) when using the conventional laparoscopic needle holder and one (0.3%) was recorded when using DEX. All of the criteria (entry and exit points, tears and duration) for the results obtained were better when using DEX compared to the classic laparoscopic tool. This difference was statistically significant for horizontal stitches and tearing. Concerning the cuts made, the global score obtained, following a multi-criteria scale, favored the use of DEX for 10 out of 12 candidates (83.3%) with an average score of + 2.6 (± 2.1). No significant difference was recorded for the duration of each exercise. Conclusion It does not take novice operators long to understand how to use DEX. It enables precise stitching and reduces tearing while improving the quality of cuts compared to conventional laparoscopic instruments, all without slowing the user down. Level of evidence 4.