title: A new multitool for hand-assisted advanced laparoscopic surgery (HALS).
abstract: BACKGROUND
  Hand-assisted laparoscopic surgery (HALS), which has become possible due to the introduction of effective hand-access devices, facilitates the execution of major operations. Over the past 2 years, we have been evaluating various designs for small instruments that can be used by the internal assisting hand. Here we report on the development, testing, and evaluation of a small reusable multitool that hangs from the little finger of the internal assisting hand of the surgeon when not in use.
  
  
  METHODS
  The Dundee Multitool (DMT) was designed to enable the internal deployment (by thumb extrusion) of a small dissecting forceps (pickup), needle driver, and scissors. The multitool hangs from the little finger of the internal assisting hand when not in use. The instrument was subjected to beta testing in the laboratory using HALS trainers. When testing was completed, it was used in major HALS operations after approval by the hospital and consent of the individual patients.
  
  
  RESULTS
  The DMT was found to work well. The various active instruments could be extruded from the casing with ease and functioned well in picking up tissues, intracorporeal suturing/tying, and the cutting of sutures and ligatures. Both in laboratory experiments and during clinical evaluation, suturing was easy when the active driving of the needle though the tissues was carried out by the external hand. The multitool needle driver, held by the internal hand as an assisting instrument in conjunction with active needle driving through the tissue edges by the dominant (external) hand, improved suturing efficiency (i.e., reduced execution time) by 30% when compared to total laparoscopic suturing.
  
  
  CONCLUSIONS
  We have described a novel little-finger-hung multitool for HALS surgery that deploys with ease at any one time. It incorporates a needle driver, a dissecting forceps, and a suture scissors. The good functionality of the multitool has been confirmed by both laboratory experiments and clinical evaluation.
authors.affiliation: Department of Surgery and Molecular Oncology, Ninewells Hospital & Medical School, University of Dundee, Dundee DD1 9SY, Scotland, UK. a.cuschieri@dundee.ac.uk
authors.forename: A
authors.initials: A
authors.lastname: Cuschieri
authors.forename: T G
authors.initials: TG
authors.lastname: Frank
authors.forename: S
authors.initials: S
authors.lastname: Brown
authors.forename: D
authors.initials: D
authors.lastname: Martin
authors.forename: J L
authors.initials: JL
authors.lastname: Gove
mesh_terms: D000818:Animals; D004867:Equipment Design; D006225:Hand; D006801:Humans; D010535:Laparoscopy; D009339:Needles; D013523:Surgical Equipment; D013525:Surgical Instruments; D013536:Suture Techniques / Q000295:instrumentation; D013552:Swine