Multifunctional instrument for operative laparoscopy: technical, experimental and clinical results in gynaecology.

Abstract

Whilst endoscopic surgical procedures are getting increasingly more complex, in the various surgical disciplines mono- and bifunctional instruments are only slowly being replaced by multifunctional ones. Therefore a complex, intelligent system was developed, the central part of which is a multifunctional instrument. All basic functions necessary for surgical laparoscopy are integrated and comprise: cutting electrodes (unipolar and bipolar) which can be advanced or retracted pneumatically; coagulation forceps with mechanical control; and irrigation and suction devices. All 5 mm instruments can be used and there is an option for others, such as laser or aqua-dissection. The various functions are controlled via the handle of the multifunctional instrument which is connected to the electronic control unit, the MULTILAP system, which supplies the energy, material, and information flow required. In vivo standardised experiments in pigs were first performed to test the new instrument. Operation time was reduced by more than 20% when compared with the same procedure performed conventionally, during which frequent changing of instruments was necessary. Clinical application, without complications in all 30 patients (uterus preserving procedures or reconstructive tubo-ovarian surgery) confirmed the advantages of a multifunctional device, with optimised cutting and coagulation of vessels more than 1-2 mm in diameter, and reduced duration of operation. Safety and ergonomics were improved. Thus, an electronically controlled instrument with multifunctional working channels for lasers, ultrasound appliances, or mechanical instruments is available for application in all domains of operative laparoscopy.