title: Low-Friction Minilaparoscopy Outperforms Regular 5-mm and 3-mm Instruments for Precise Tasks.
abstract: OBJECTIVE
  Therapeutic laparoscopy was incorporated into surgical practice more than 25 y ago. Several modifications have since been developed to further minimize surgical trauma and improve results. Minilaparoscopy, performed with 2- to 3-mm instruments was introduced in the mid 1990s but failed to attain mainstream use, mostly because of the limitations of the early devices. Buoyed by a renewed interest, new generations of mini instruments are being developed with improved functionality and durability. This study is an objective evaluation of a new set of mini instruments with a novel low-friction design.
  
  
  METHODS
  Twenty-two medical students and 22 surgical residents served as study participants. Three designs of laparoscopic instruments were evaluated: conventional 5mm, traditional 3 mm, and low-friction 3 mm. The instruments were evaluated with a standard surgical simulator, emulating 4 exercises of various complexities, testing grasping, precise 2-handed movements, and suturing. The metric measured was time to task completion, with 5 replicates for every combination of instrument-exercise-participant.
  
  
  RESULTS
  For all 4 tasks, the instrument design that performed the best was the same in both the medical student and surgical resident groups. For the gross-grasping task, the 5-mm conventional instruments performed best, followed by the low-friction mini instruments. For the 3 more complex and precise tasks, the low-friction mini instruments outperformed both of the other instrument designs.
  
  
  CONCLUSIONS
  In standard surgical simulator exercises,low-friction minilaparoscopic instruments outperformed both conventional 3- and 5-mm laparoscopic instruments for precise tasks.
authors.forename: Wood A
authors.initials: WA
authors.lastname: Firme
authors.forename: Gustavo L
authors.initials: GL
authors.lastname: Carvalho
authors.forename: Diego L
authors.initials: DL
authors.lastname: Lima
authors.forename: Vladmir Goldstein de Paula
authors.initials: VG
authors.lastname: Lopes
authors.forename: Isabelle D
authors.initials: ID
authors.lastname: Montandon
authors.forename: Flavio
authors.initials: F
authors.lastname: Santos Filho
authors.forename: Phillip P
authors.initials: PP
authors.lastname: Shadduck
mesh_terms: D000328:Adult; D004501:Education, Medical; D004867:Equipment Design; D017276:Friction; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000193:education / Q000295:instrumentation*; D008904:Miniaturization