A multi-degree-of-freedom needle driver with a short tip and small shaft for pediatric laparoscopic surgery: in vivo assessment of multi-directional suturing on the vertical plane of the liver in rabbits

BackgroundLaparoscopic Kasai portoenterostomy has been performed in infants with biliary atresia at several institutions, but laparoscopic anastomosis requiring multi-directional suturing on a vertical plane of the liver remains a challenge. To assist multi-directional suturing, we developed a multi-degree-of-freedom (DOF) needle driver whose tip length was 15 mm and shaft diameter was 3.5 mm. The tip of the multi-DOF needle driver has three DOFs for grasp, flection and rotation. The aim of this study was to evaluate the performance of the multi-DOF needle driver in two kinds of in vivo experiments.MethodsSurgeons were asked to perform four-directional laparoscopic suturing on a vertical plane of the liver in six rabbits using the multi-DOF needle driver or a conventional needle driver. The needle grasping time, the needle handling time, the number of needle insertions, the number of liver lacerations, the suturing width and depth, and the area of necrotic tissues were analyzed and compared. Additionally, one surgeon was asked to perform laparoscopic hepato-jejunostomy in four rabbits to assess the feasibility of Kasai portoenterostomy using the multi-DOF needle driver.ResultsThe suturing depth using the multi-DOF needle driver was significantly larger than that using the conventional needle driver in both the right and downward suturing directions. No statistically significant differences were found in other metrics. Liver lacerations were observed only when suturing was performed using the conventional needle driver. The experimental laparoscopic hepato-jejunostomy using the multi-DOF needle driver was successful.ConclusionsUsing the multi-DOF needle driver, uniform multi-directional suturing on a vertical plane of the liver could be performed. The short distal tip of the multi-DOF needle driver demonstrated its advantages in multi-directional suturing in a small body cavity. The multi-DOF needle driver may be able to be used to perform complex tasks in laparoscopic Kasai portoenterostomy.

[1]  A. Sandler,et al.  The robotic approach to complex hepatobiliary anomalies in children: preliminary report. , 2007, Journal of pediatric surgery.

[2]  A. Cuschieri,et al.  Effect of intracorporeal-extracorporeal instrument length ratio on endoscopic task performance and surgeon movements. , 2000, Archives of surgery.

[3]  P. Tam,et al.  Should open Kasai portoenterostomy be performed for biliary atresia in the era of laparoscopy? , 2008, Pediatric Surgery International.

[4]  N Di Lorenzo,et al.  Radius surgical system and conventional laparoscopic instruments in abdominal surgery: application, learning curve and ergonomy. , 2007, Surgical oncology.

[5]  Blake Hannaford,et al.  Assessment of Tissue Damage due to Mechanical Stresses , 2006, The First IEEE/RAS-EMBS International Conference on Biomedical Robotics and Biomechatronics, 2006. BioRob 2006..

[6]  Mamoru Mitsuishi,et al.  A novel approach to the design of a needle driver with multiple DOFs for pediatric laparoscopic surgery , 2013, Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy.

[7]  Mamoru Mitsuishi,et al.  Design of intuitive user interface for Multi-DOF forceps for laparoscopic surgery , 2011, 2011 IEEE International Conference on Robotics and Automation.

[8]  N. Kim,et al.  Simultaneous development of laparoscopy and robotics provides acceptable perioperative outcomes and shows robotics to have a faster learning curve and to be overall faster in rectal cancer surgery: analysis of novice MIS surgeon learning curves , 2015, Surgical Endoscopy.

[9]  S. Kawasaki,et al.  Experience of treating biliary atresia with three types of portoenterostomy at a single institution: extended, modified Kasai, and laparoscopic modified Kasai , 2014, Pediatric Surgery International.

[10]  Wei-Jei Lee,et al.  Recent advances in laparoscopic surgery , 2013, Asian journal of endoscopic surgery.

[11]  Makoto Hashizume,et al.  Ultra-minimally invasive local immune cell therapy and regenerative therapy by multi-piercing surgery for abdominal solid tumor: therapeutic simulation by natural orifice translumenal endoscopic surgery-assisted needlescopic surgery using 3-mm diameter robots , 2011, Journal of hepato-biliary-pancreatic sciences.

[12]  Guillaume Morel,et al.  Evaluation of the effect of a laparoscopic robotized needle holder on ergonomics and skills , 2016, Surgical Endoscopy.

[13]  Andreas Hackethal,et al.  Handheld articulating laparoscopic instruments driven by robotic technology. First clinical experience in gynecological surgery , 2012, Gynecological Surgery.

[14]  S. Chin,et al.  Comparison of the effects of surgical dissection devices on the rabbit liver , 2014, Surgery Today.

[15]  Sanjeev Dutta,et al.  Minimal access portoenterostomy: advantages and disadvantages of standard laparoscopic and robotic techniques. , 2007, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[16]  James G Bittner,et al.  Three-dimensional visualisation and articulating instrumentation: Impact on simulated laparoscopic tasks , 2008, Journal of Minimal Access Surgery.

[17]  G. Buess,et al.  Laparoscopic intracorporal colorectal sutured anastomosis using the Radius Surgical System in a phantom model , 2009, Surgical Endoscopy.

[18]  Claus Petersen,et al.  Survival With the Native Liver After Laparoscopic Versus Conventional Kasai Portoenterostomy in Infants With Biliary Atresia: A Prospective Trial , 2011, Annals of surgery.

[19]  S. Langenburg,et al.  Robot-assisted minimally invasive Kasai portoenterostomy: a survival porcine study , 2004, Surgical Endoscopy And Other Interventional Techniques.

[20]  Karen A. Diefenbach,et al.  Utilization and costs associated with robotic surgery in children. , 2015, The Journal of surgical research.

[21]  George B. Hanna,et al.  Influence of instrument size on endoscopic task performance in pediatric intracorporeal knot tying , 2007, Surgical Endoscopy.

[22]  M. Schurr,et al.  Precision in stitches: Radius Surgical System , 2007, Surgical Endoscopy.

[23]  Chen Zhen,et al.  Laparoscopic portoenterostomy versus open portoenterostomy for the treatment of biliary atresia: a systematic review and meta-analysis of comparative studies , 2015, Pediatric Surgery International.

[24]  Laparoscopic Treatment for Esophageal Achalasia and Gastro-Esophago-reflex Disease Using Radius Surgical System , 2013, Indian Journal of Surgery.

[25]  Mamoru Mitsuishi,et al.  Development of a needle driver with multiple degrees of freedom for neonatal laparoscopic surgery. , 2013, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[26]  M. Mitsuishi,et al.  Assessment of suturing in the vertical plane shows the efficacy of the multi-degree-of-freedom needle driver for neonatal laparoscopy , 2013, Pediatric Surgery International.

[27]  Dogu Teber,et al.  The radius surgical system - a new device for complex minimally invasive procedures in urology? , 2007, European urology.

[28]  K. Ozawa,et al.  Granulation at the porta hepatis following hepatic portoenterostomy for biliary atresia: the healing of experimental hepatoenterostomy. , 1989, Journal of pediatric surgery.