Thinner Minilaparoscopic Instruments Ease Procedural Tasks

A new study that examined surgeons’ perceptions of transanal endoscopic microsurgery (TEM) using minilaparoscopic instruments reveals that thinner is better.

Researchers at the University of Sao Paulo (USP; Brazil), the Federal University of Pernambuco (Recife, Brazil), and other institutions hypothesized that visualization and maneuverability during TEM performed with 3-mm minilaparoscopic instruments would be superior to TEM performed with conventional 5-mm instruments. To test their hypothesis, 18 general and colorectal surgeons with minimal experience with TEM (i.e., under ten cases) were recruited to complete two tasks using a rectal simulator.

The first task was to use conventional 5-mm transanal endoscopic operation (TEO) curved-tip instruments to excise a 2-cm polypoid lesion, followed by closure of the rectal defect, all without previous instruction. In the second task, the same participants repeated the same excision and closure procedure, but this time using 3-mm mini-laparoscopic instruments. After completing both tasks, the participants filled an evaluation questionnaire containing seven questions regarding visualization and maneuverability, comparing the two sets of instruments on a scale of 1–5.

The results showed that for each one of the seven questions, all surgeons pointed out that their movements were more precise with 3-mm forceps, with 94.4% feeling more comfortable to complete the task. Only one surgeon claimed that the result was the same as he expected for conventional 5-mm forceps. All surgeons agreed that mini-laparoscopic instruments offered superior visualization for the proposed task. The study was published on January 8, 2014, in Surgical Endoscopy.

“Minilaparoscopic low-friction 3-mm instruments offered better visualization and were more reliable according to surgeons’ perception during task performance in a Neoderma TEO simulator,” concluded lead author Sergio Eduardo Alonso Araujo, PhD, of USP, and colleagues. “With mini-instruments it was easier and more comfortable to complete the procedure when compared with the conventional TEO instruments.”

The simulator used was a Neoderma trainer, which consists of a 30-cm long, 4-cm wide cylinder filled with neoderma, a synthetic material offering color, touch, consistency and texture similar to human tissues. The simulator is naturally self-expanded and closed at one end, simulating a gas-inflated rectum.

Related Links:
University of Sao Paulo
Federal University of Pernambuco