Conventional Laparoscopic vs Multi-Degree of Freedom Articulating Instruments in Minimally Invasive Surgical Suturing.

Abstract

Study ObjectiveThe Artisential instruments are multi-degree-of-freedom laparoscopic instruments compatible with traditional ports. Their articulation may offer advantages over conventional instruments, particularly in suturing. This study aimed to compare suturing times between conventional laparoscopic instruments and the Artisential device.DesignInternally controlled prospective cohort/case series.InterventionsA power analysis determined that 16 knots per group were needed to detect a 20s difference with 80% power and 5% alpha. Two patients undergoing laparoscopic sacrocolpopexy were enrolled. During anterior and posterior mesh fixation, half the knots were tied using two conventional laparoscopic needle drivers; the other half used an Artisential needle driver in one hand and a conventional driver in the other. All knots were tied by the same surgeon, positioned adjacently to minimize bias from laterality or pelvic depth. Each knot consisted of a surgeon's knot followed by two square knots. All cases were recorded and evaluated by 2 reviewers, using time stamps to determine knot tying duration. T-tests compared times between the groups.Measurements and Main ResultsThirty-two knots were analyzed. Mean knot time was 119 s (SD 43) with conventional instruments vs 66 s (SD 14) using the Artisential device (<i>P</i> < .01). All individual components-needling, surgeon's knot, and both square knots-were significantly faster with the Artisential driver (all <i>P</i> < .05).ConclusionThe Artisential articulating laparoscopic instrument nearly halved knot-tying time during laparoscopic sacrocolpopexy. This novel instrument may improve surgical efficiency in minimally invasive gynecologic procedures.