title: Use of a novel multi-purpose sponge for laparoscopic surgery: Does it have special relevance to robotically-assisted laparoscopic surgery?
abstract: BACKGROUND
  The STAR System (Ekymed SpA) is a novel multipurpose sponge developed for conventional manual laparoscopic surgery.
  
  
  METHODS
  Between December 2012 and December 2014, we successfully used the sponge in ten robot-assisted and ten direct manual laparoscopic operations to achieve haemostasis, for blunt dissections, for atraumatic lifting of solid organs, to check for bile leaks, for cleaning the surgical field thus avoiding frequent use of suction or the application of haemostatic agents. The reason of the insertion (RI), the main use (MU) and any further use (FU), once inserted, were registered for each operation and compared between the two groups.
  
  
  RESULTS
  The principal RI was haemostasis for minor bleeding, without differences between the two groups (P = not significant). Regard to MU, in the robotic group cleaning the surgical field was utilised more than laparoscopic group (100% vs. 60%; P = 0.03). About FU, atraumatic solid organs lifting was more frequent during robotically assisted surgery than with laparoscopy (50% vs. 0%; P = 0.01). A statistically more frequent use of the sponge was registered during standard laparoscopy for the blunt dissection (30% vs. 80%; P = 0.03).
  
  
  CONCLUSIONS
  The STAR System was beneficial in both approaches, but it imparts added benefit during robotically-assisted laparoscopic surgery organs because of the lack of tactile feedback and because the operating surgeon is remote from the patient, and has to rely on the assisting surgeon in the sterile field for dealing with bleeding episodes, cleansing/mopping the operative field when necessary, who may not be experienced or completely proficient.
authors.affiliation: EndoCAS, Center for Computer Assisted Surgery, University of Pisa; General Surgery Unit, Department of Oncology Transplantation and New Technologies, University of Pisa, Pisa, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Morelli
authors.affiliation: General Surgery Unit, Department of Oncology Transplantation and New Technologies, University of Pisa, Pisa, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Guadagni
authors.affiliation: BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Troia
authors.affiliation: General Surgery Unit, Department of Oncology Transplantation and New Technologies, University of Pisa, Pisa, Italy.
authors.forename: Gregorio
authors.initials: G
authors.lastname: Di Franco
authors.affiliation: General Surgery Unit, Department of Oncology Transplantation and New Technologies, University of Pisa, Pisa, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Palmeri
authors.affiliation: General Surgery Unit, Department of Oncology Transplantation and New Technologies, University of Pisa, Pisa, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Caprili
authors.affiliation: General Surgery Unit, Department of Oncology Transplantation and New Technologies, University of Pisa, Pisa, Italy.
authors.forename: Cristiano
authors.initials: C
authors.lastname: D'Isidoro
authors.affiliation: EndoCAS, Center for Computer Assisted Surgery, University of Pisa, Pisa, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Moglia
authors.affiliation: General Surgery Unit, Department of Oncology Transplantation and New Technologies, University of Pisa, Pisa, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Pisano
authors.affiliation: Division of General Surgery, University of Pavia, Pavia, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Pietrabissa
authors.affiliation: BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.
authors.forename: Alfred
authors.initials: A
authors.lastname: Cuschieri
authors.affiliation: EndoCAS, Center for Computer Assisted Surgery, University of Pisa, Pisa, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Mosca