title: Laparoscopic gastro-jejunal anastomosis using novel r2 deflectable instruments in an ex vivo model.
abstract: OBJECTIVE
  A novel 5 mm steerable instrument system (r2-DRIVE) was developed with active tip deflection and tip and shaft rotation. The feasibility and training effect of the r2 instruments were determined in a phantom model.
  
  
  METHODS
  Experienced laparoscopic surgeons and untrained novices performed laparoscopic gastro-jejunal anastomoses using porcine tissue and r2 DRIVE-instruments. Mean anastomosis time, anastomosis width and burst pressure were measured. Number of stitches, skipped stitches and dropped needles were counted. Results of trained and untrained subjects were compared.
  
  
  RESULTS
  Mean time for suturing decreased rapidly for all participants, but was more evident for untrained persons. After five anastomoses no relevant improvement in anastomotic time was seen for the skilled group. The ease of use, efficacy of manipulation and swift training effect with the novel r2 instruments for both experienced laparoscopic surgeons and untrained non-surgeons could be demonstrated and after few cases stable anastomosis times and a fast learning curve were obtained.
  
  
  CONCLUSIONS
  This study demonstrates the ease of use, efficacy of manipulation and swift training effect with the novel r2 instruments for both experienced laparoscopic surgeons and untrained non-surgeons. After few cases stable anastomosis times and a fast learning curve were obtained.
authors.affiliation: a Department General , Visceral and Transplant Surgery, University Hospital Tuebingen , Tuebingen , Germany ;
authors.forename: Marty
authors.initials: M
authors.lastname: Zdichavsky
authors.affiliation: b novineon CRO , Tuebingen , Germany ;
authors.forename: Martina
authors.initials: M
authors.lastname: Krautwald
authors.affiliation: a Department General , Visceral and Transplant Surgery, University Hospital Tuebingen , Tuebingen , Germany ;
authors.forename: Maximilian V
authors.initials: MV
authors.lastname: Feilitzsch
authors.affiliation: a Department General , Visceral and Transplant Surgery, University Hospital Tuebingen , Tuebingen , Germany ;
authors.forename: Dörte
authors.initials: D
authors.lastname: Wichmann
authors.affiliation: a Department General , Visceral and Transplant Surgery, University Hospital Tuebingen , Tuebingen , Germany ;
authors.forename: Alfred
authors.initials: A
authors.lastname: Königsrainer
authors.affiliation: c IHCI Institute, Steinbeis University Berlin , Tuebingen , Germany.
authors.forename: Marc Oliver
authors.initials: MO
authors.lastname: Schurr
mesh_terms: D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods*; D000818:Animals; D002983:Clinical Competence; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D059032:Learning Curve; D066231:Surgeons / Q000592:standards; D013536:Suture Techniques; D013552:Swine
keywords: Deflectable instruments; gastro-jejunal anastomosis; instruments; laparoscopic