Can multiple-degree-of-freedom articulating instruments be effective in pediatric endoscopic surgery? - A prospective trial

Background: Pediatric endosurgery often requires intracorporeal suturing, including reverse or vertical needle driving, which is difficult using a conventional instrument because of limited degrees of freedom (DOFs). To address this, multiple-DOF (mDOF) articulating instruments (mDOF-AIs) have been developed. We therefore evaluated the usefulness of mDOF-AIs compared with conventional instruments. Methods: ARTISENTIALⓇ (LivsMed, Seongnum-si, Republic of Korea) was used as the mDOF-AI. Forty medical students were randomly divided into groups using conventional or mDOF articulating graspers to compare their proficiency with three-dimensional peg transfer. Task completion time and number of errors (dropping a peg) were evaluated. In addition, among pediatric surgeon participants, the number of practice times taken to reach the goal (completion of peg transfer within two minutes and vertical suturing) was measured. After achieving the goal, three vertical sutures of laparoscopic hepaticojejunostomy of the simulator were performed using the conventional and mDOF articulating needle-driver. The task completion time and quality of suturing were then evaluated. Results: Forty medical students were enrolled. The mDOF group showed significantly longer task completion times but significantly fewer errors than the conventional group (0.7 vs. 1.4 times, p = 0.03). Six pediatric surgeons achieved the goal in 42.5 min of practice on average. Using the mDOF articulating needle-driver, laparoscopic hepaticojejunostomy took significantly longer than with the conventional needle-driver (1120 vs. 856 s, p<0.01); however, the suturing quality improved significantly. Conclusion: The quality of basic and advanced endoscopic procedures using mDOF-AIs was higher than that with conventional instruments. mDOF-AIs potentially have safe and accurate performance.