Experimental assessment of a new mechanical endoscopic solosurgery system: Endofreeze

  • A. Arezzo
  • M. O. Schurr
  • A. Braun
  • G. F. BuessEmail author
Original article



The assistance received by the surgeon from support personnel during operative laparoscopy is extremely important. This includes retraction of instruments and endoscope positioning. However, human assistance is costly and often does not provide satisfaction for the surgeon. The aim of this study was to develop a mechanical arm capable of allowing easy handling and holding of laparoscopic instruments under the surgeon’s control.


We designed a system, named Endofreeze, based on a particular kinematical construction that maintains an invariant point of constraint motion just above the trocar puncture site through the abdominal wall. The goal was to develop this way a highly intuitive mechanical holding system for laparoscopic instruments, with sufficient precision of action, activated by a single hand movement. We tested a couple of prototypes with different holding arms while performing cholecystectomy in phantom models with swine inserts and compared the results obtained in similar conditions using different holding and positioning systems.


The system allows transparent and intuitive operation, and its setup is easy and quick. It may be adapted either as an instrument retractor or as an optic positioning device. Compared to different systems available or prototypes previously tested, such as AESOP 2000, ENDOASSIST, FIPS Endoarm, TISKA Endoarm, and the Martin Arm, in similar conditions, it was more intuitive, allowing shorter time for completion of surgery.


Endofreeze is a new intuitive mechanical positioning system for endoscopic solo surgery. In phantom models, it demonstrated a shorter time requirement for completion of surgery when compared to other systems available. In our opinion, it represents a valid compromise between human and robotic control for conventional laparoscopic instruments.


Endoscopic surgery Retractors Surgical Robotics Solo surgery 



We thank Dr. Theodor Lutze and Dr. Dieter Weisshaupt of Aesculap AG & CO. KG (Tuttlingen, Germany) for their support in the development of the Endofreeze system.


  1. 1.
    Arezzo, A, Ulmer, F, Weiss, O, Schurr, MO, Hamad, M, Buess, GF 2000Experimental trial on solo surgery for minimally invasive therapy: comparison of different systems in a phantom modelSurgl Endosc14955959CrossRefGoogle Scholar
  2. 2.
    Benabid, AL, Lavallee, S, Hoffmann, D, Cinquin, P, Demongeot, J, Danel, F 1992Potential use of robots in endoscopic neurosurgeryActa Neurochir Suppl549397Google Scholar
  3. 3.
    Buess, GF, Arezzo, A, Schurr, MO, Ulmer, F, Fischer, H, Gumb, L, Testa, T, Nobman, C 2000A new remote-controlled endoscope positioning system for endoscopic solo surgerySurg Endosc14395399CrossRefPubMedGoogle Scholar
  4. 4.
    Davies, BL, Hibberd, RD, Coptcoat, MJ, Wickham, JE 1989A surgeon robot prostatectomy-a laboratory evaluationJ Med Eng Technol13273277PubMedGoogle Scholar
  5. 5.
    Finlay, PA, Ornstein, MH 1995Controlling the movement of a surgical laparoscopeIEEE Eng Med Biol14289291CrossRefGoogle Scholar
  6. 6.
    Glantz, SA 1996Primer of Biostatistics, Version 4.0McGraw-HillNew YorkGoogle Scholar
  7. 7.
    Kelly, PJ, Kail, BA, Goerss, S, Earnest, F 1986Computer assisted stereotactic laser resection of intra-axial brain neoplasmJ Neurosurg64427439PubMedGoogle Scholar
  8. 8.
    Koyama, H, Uchida, T, Funakubo, H, Takakura, K, Fankhauser, H 1990Development of a new microsurgical robot for stereotactic neurosurgeryStereotact Funct Neurosurg54-55462467PubMedGoogle Scholar
  9. 9.
    Matsen, FA, Garbini, JL, Sidles, JA, Pratt, B, Baumgarten, D, Kaiura, R 1993Robotic assistance in orthopaedic surgery. A proof of principle using distal femoral arthroplastyClin Orthop296178186PubMedGoogle Scholar
  10. 10.
    Mueglitz, J, Kunad, , Dautzenberg, P, Neisius, B, Trapp, R 1993Kinematic problems of manipulators in minimally invasive surgeryEndosc Surg Allied Technol1160164PubMedGoogle Scholar
  11. 11.
    Sackier, JM, Wang, Y 1994Robotically assisted laparoscopic surgery. From concept to developmentSurg Endosc86366PubMedGoogle Scholar
  12. 12.
    Schurr, MO, Arezzo, A, Neisius, B, Rininsland, HH, Hilzinger, HU, Dorn, J, Roth, K, Buess, GF 1999Trocar and instrument positioning system TISKA: an assist device for endoscopic solo-surgerySurg Endosc13528531CrossRefPubMedGoogle Scholar
  13. 13.
    Taylor, KS 1993Robodoc: study tests robot’s use in hip surgeryHospitals6746Google Scholar
  14. 14.
    Traverse, LW, Koo, KP, Hargrave, K,  et al. 1997Standardizing laparoscopic procedure time and determining the effect of patient age/gender or absence of surgical residents during operationsSurg Endosc11226229CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • A. Arezzo
    • 1
    • 2
  • M. O. Schurr
    • 2
    • 3
  • A. Braun
    • 3
  • G. F. Buess
    • 2
    • 3
    Email author
  1. 1.Chirurgia GeneraleOspedale Evangelico Internazionale16122 GenovaItaly
  2. 2.Section for Minimally Invasive Surgery, Department of General SurgeryEberhard-Karls-UniversityTuebingenGermany
  3. 3.Tuebingen Scientific, Waldhoernlestrasse 22TuebingenGermany

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