Initial experience with ArtiSential articulating laparoscopic instruments in the paediatric setting: a single-centre feasibility study

Purpose This study describes the learning curve associated with ArtiSential articulating laparoscopic instruments (ALI) in a simulated environment and the early paediatric clinical implementation of this skill set. Methods The study was performed as a single-centre feasibility study. Baseline performance for a peg board transfer task requiring 3D object translation was established with standard instruments (SI) and ALI. Completion time and number of pegs dropped were recorded. Participants completed 5 h of distributed practice followed by a repeat timed performance. ArtiSential articulating instruments were subsequently used in 3 laparoscopic cases using an iterative learning model and the learning points are described. Results Median baseline completion time with SI and ALI were not significantly different [7.3 min SI vs 10.5 min ALI ( p = 0.138), ALI times significantly improved with 5 h training (10.5 min vs 3.5 min ( p = 0.014)]. 19 pegs were dropped using SI, while 7 were dropped with ALI ( p = 0.028). Two laparoscopic cholecystectomies and a laparoscopic fundoplication were performed using a hybrid approach with articulating instruments and standard laparoscopic instruments with operating times of 164, 94 and 120 min, respectively. Conclusions There is a short learning curve with rapid acquisition of the articulating skill set using this training program, with intuitive translation to the clinical setting, permitting increased dexterity and range of movement compared to SI. Limitations including air-leak and loss of angulation during dissection respond to modification of surgical set-up and refining technique.