Handheld Devices for Laparoscopic Surgery

Despite the well-known benefits of minimally invasive surgery (MIS) to the patients, this surgical technique implies some technical challenges for surgeons. These technical limitations are increased with the introduction of laparoendoscopic single-site (LESS) surgery. In order to overcome some of these technical difficulties, new handheld devices have been developed, providing improved functionalities along with precision-driven and articulat- ing instrument tips. In this chapter, we will review the current status of handheld devices for laparoscopy and LESS surgery. Devices that provide additional and innovative func- tionalities in comparison with conventional surgical instruments will be considered. Results will be based on studies published in the scientific literature and our experience. These surgical devices will be organized into two main groups, mechanical devices and robotic-driven devices. In general, these instruments intend to simulate the dexterity of movements of a human wrist. Mechanical devices are cheaper and easier to develop, so most of the available handheld instruments fall into this category. The majority of the robotic-driven devices are needle holders with an articulating tip, controlled by an interface implemented on the instrument handle. In general, these handheld devices claim to offer an enhancement of dexterity, precision, and ergonomics. Results showed that, although both instruments offer similar technical performance, the robotic-driven instrument results in better ergonomics for the surgeon ’ s hand posture during intracorporeal suturing. Besides, we recently conducted a study in which five experienced laparoscopic surgeons performed an urethrovesical anastomosis in a porcine model using the DEX ™ system (unpublished study) ( Figure 3 ). Participants used both a conventional axial-handled laparoscopic needle holder and the robotic instrument. Execution time, surgeon ’ s posture, and pressure exerted by the surgeon ’ s hand were assessed. Results revealed that the DEX ™ system led to better ergonomics for the surgeon ’ s hand, without differences in muscle fatigue between instruments. The robotic device required applying less pressure on the handle by the surgeons during surgery. similar surgical performance. Studies showed that handheld articulating devices facilitate intracorporeal suturing with similar surgery time and outcomes to conventional laparoscopy. Many of the presented handheld instruments are still in early stages of development. Additional efforts should be done in order to improve their functionalities and make them more intuitive. Besides, further innovative solutions should be explored in order to exploit the full potential of LESS surgery. The introduction of novel handheld devices in MIS should be accompanied by a comprehensive training period in order to reach the appropriate level of surgical proficiency.