Laparoscopic intracorporal colorectal sutured anastomosis using the Radius Surgical System in a phantom model.
BACKGROUND
The Radius Surgical System (RSS) is a manipulator with additional degrees of freedom to enhance the dexterity of laparoscopic suturing. Our aim was to determine the feasibility and potentially added value of laparoscopic intracorporal sutured colorectal anastomosis (RSS) compared with suturing with conventional laparoscopic instruments (CLI).


METHODS
A total of 72 colorectal anastomoses and 30 single sutures using RSS and CLI were performed in the study. The experiment was divided as follows: One surgeon performed 40 colorectal anastomoses using RSS to assess the learning curve and the feasibility of the technique; The same surgeon performed 10 additional colorectal anastomoses with CLI which were then compared to the last 10 cases of the 40 anastomoses with RSS; Fifteen single sutures in the horizontal plane with RSS and 15 with CLI between two segments of colon were performed to compare the traction force to disrupt the suture; Twelve anastomoses were performed by the other three participants to evaluate ergonomy.


RESULTS
Three leakages (7.5%) were found in the 40 anastomoses with RSS but none after the eighth case. There was no stenosis. The mean time for the anastomoses once the learning curve was achieved was 32.7 min. After 21 anastomoses with RSS there was no improvement in the operating time. The quality of the suture was superior with RSS, with a larger anastomosis diameter, higher bursting pressure, and fewer suturing failures being found. The RSS suture withstood a higher traction force. The participants showed more discomfort suturing with CLI.


CONCLUSIONS
This study demonstrated the feasibility of laparoscopic colorectal anastomosis using RSS. Anastomosis with RSS was shown to be safer. The three participants evaluating ergonomy reflected less discomfort in hand/wrist using RSS. Others ergonomic problems were comparable to CLI.
Torres Bermudez
J R
JR
Department of General, Section for Minimaly Invasive Surgery, Tuebingen University, Tuebingen, Germany.
Buess
G
G
Waseda
M
M
Gacek
I
I
Becerra Garcia
F
F
Manukyan
G A
GA
Inaki
N
N
Inaky
N
N
D000714:Anastomosis, Surgical; D000818:Animals; D001416:Back Pain / Q000209:etiology; D002417:Cattle; D003106:Colon / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007858:Learning; D018763:Muscle Fatigue; D010820:Physicians / Q000523:psychology; D011214:Practice, Psychological; D011597:Psychomotor Performance; D012007:Rectum / Q000601:surgery*; D013315:Stress, Psychological / Q000209:etiology; D013536:Suture Techniques / Q000295:instrumentation*; D013718:Tensile Strength