Laparoscopy generates technical and ergonomics difficulties due to limited degrees of freedom (DOF) of forceps. To reduce this limitation, a new 5-mm robotized needle holder with two intracorporeal DOF, Jaimy®, has been developed. The aim of this study was to evaluate its effects on ergonomics and skills.
Fourteen surgeons including eight senior and six residents were crossover randomized and stratified based on experience. Three suturing tasks were performed with both Jaimy® and a classic needle holder (NH): task 1: Peg-Board; task 2: hexagonal suture; task 3: frontal suture. Postural ergonomics of the dominant arm were evaluated with an ergonomics score (RULA score) thanks to motion capture, and muscular ergonomics with electromyography of six muscular groups (flexor and extensor carpis, biceps, triceps, deltoid, trapeze). Performance outcomes are a quantitative and qualitative score, and skills outcomes are the measurement of the number of movements and the path length travelled by the instrument.
The RULA score showed a statistically improved posture with Jaimy® (p < 0.001). The cumulative muscular workload (CMW) of four muscles was not different. However, the CMW was in favor of the NH for the flexor carpi ulnaris (p < 0.001) and the triceps (p = 0.027). The number of movements was not different (p = 0.39) although the path length was shorter with Jaimy® (p = 0.012). The score for task 1 was in favor of the NH (p = 0.006) with a higher quantity score. Task 2 score was not different (p = 0.086): The quality part of the score was in favor of Jaimy® (p = 0.009) and the quantity part was higher with the NH (p = 0.04). The score for task 3 was higher with Jaimy® (p = 0.001).
This study suggests that the use of a robotized needle holder improves both posture and the quality of laparoscopic sutures.
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This work was partially supported by French state funds managed by the ANR within the Investissements d’Avenir program (Labex CAMI) under reference ANR-11-LABX-0004 and through the FUI Fluoromis project.
Guillaume Morel is a scientific advisor for the company Endocontrol who commercializes the robotized instrument Jaimy. To deal with this conflict of interest, he was involved only in the design of the experimental setup and the technical construction of the measurement systems, but he was not present during the experiments and did not participate in the data collection nor in the statistical analysis of the results. He then participated in the analysis of the statistical results (discussion section). Thierry Bensignor, David Reversat, David Fuks and Brice Gayet have no conflict of interest.
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Bensignor, T., Morel, G., Reversat, D. et al. Evaluation of the effect of a laparoscopic robotized needle holder on ergonomics and skills. Surg Endosc 30, 446–454 (2016). https://doi.org/10.1007/s00464-015-4217-7
- Laparoscopic needle holder
- Robotized instrument
- Skill assessment
- Motion capture