Pre-Bent Instruments Preferred in Single-Site Surgery

A new study of laparoendoscopic single-site (LESS) surgery instruments has concluded that pre-bent instruments were less time consuming and offered better maneuverability than newer flexible instruments.

Researchers at the University of Leipzig (Germany) conducted a comparative assessment of recently introduced pre-bent LESS instruments to conventional laparoscopic instruments, in a laboratory setting. The researchers compared the efficacy of both conventional and flexible instruments in terms of time requirement, maneuverability, and ease of handling in both dry and animal models. To do so, study participants of varying laparoscopic experience were divided in groups according to their experience; the participants then performed predetermined tasks in dry laboratory using all sets of instruments. An experienced laparoscopic surgeon then performed 24 nephrectomies in 12 pigs using all sets of instruments. A single port was used for all instrument sets except for the conventional instruments, which were inserted through three distinct ports. Performance times were recorded, as were errors in the performance of dry laboratory tasks of each instrument type.

The researchers found that pre-bent instruments had a significant advantage over flexible instruments, both in terms of the time required to accomplish tasks and procedures, as well as maneuverability; the flexible instruments were also more time consuming during the performance of the tasks. When using conventional instruments through an appropriate number of ports (usually three), no significant differences in the time required for the accomplishment of dry laboratory tasks or the stages of a nephrectomy were found, when compared to the results of using pre-bent instruments used through a single port. The study was published in the February 2010 issue of the Journal of Endourology.

"It is clear from this study that further clinical evaluations will be required to further determine the efficacy and effectiveness of pre-bent laparoscopic instruments for LESS surgery,” concluded lead author Professor Jens-Uwe Stolzenburg, M.D., Ph.D., and colleagues of the department of urology.

LESS is performed through a single umbilical port that accommodates three laparoscopic instruments. However, special instruments and techniques are necessary to work from this confined platform, and the procedure is associated with a steep learning curve, even for laparoscopically experienced surgeons. The instruments used for this technique can be pre-bent conventional laparoscopic instruments or newly developed flexible instruments.

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University of Leipzig