Institute of Automatic Control Engineering, Fakultät für Elektro- und Informationstechnik, Technische Universität München, Theresienstraße 90, 80290, Munich, Germany.
Surg Endosc. 2011 Jul;25(7):2100-4. doi: 10.1007/s00464-010-1532-x. Epub 2011 Feb 7.
In minimally invasive surgery, hand suturing is categorized as a challenge in technique as well as in its duration. This calls for an easily manageable tool, permitting an all-purpose, cost-efficient, and secure viscerosynthesis. Such a tool for this field already exists: the Autosuture EndoStitch(®). In a series of studies the potential for the EndoStitch to accelerate suturing has been proven. However, its ergonomics still limits its applicability. The goal of this study was twofold: propose an optimized and partially automated EndoStitch and compare the conventional EndoStitch to the optimized and partially automated EndoStitch with respect to the speed and precision of suturing.
Based on the EndoStitch, a partially automated suturing tool has been developed. With the aid of a DC motor, triggered by a button, one can suture by one-fingered handling. Using the partially automated suturing manipulator, 20 surgeons with different levels of laparoscopic experience successfully completed a continuous suture with 10 stitches using the conventional and the partially automated suture manipulator. Before that, each participant was given 1 min of instruction and 1 min for training. Absolute suturing time and stitch accuracy were measured. The quality of the automated EndoStitch with respect to manipulation was tested with the aid of a standardized questionnaire.
To compare the two instruments, t tests were used for suturing accuracy and time. Of the 20 surgeons with laparoscopic experience (fewer than 5 laparoscopic interventions, n=9; fewer than 20 laparoscopic interventions, n=7; more than 20 laparoscopic interventions, n=4), there was no significant difference between the two tested systems with respect to stitching accuracy. However, the suturing time was significantly shorter with the Autostitch (P=0.01). The difference in accuracy and speed was not statistically significant considering the laparoscopic experience of the surgeons. The weight and size of the Autostitch have been criticized as well as its cable. However, the comfortable handhold, automatic needle change, and ergonomic manipulation have been rated positive.
Partially automated suturing in minimally invasive surgery offers advantages with respect to the speed of operation and ergonomics. Ongoing work in this field has to concentrate on minimization, implementation in robotic systems, and development of new operation methods (NOTES).
在微创手术中，手缝术既具有技术挑战性，又耗时较长。因此，我们需要一种易于操作的工具，实现通用、经济高效且安全的内脏缝合。Autosuture EndoStitch（®）就是这样一种工具。在一系列研究中，已经证明了 EndoStitch 具有加速缝合的潜力。然而，其人体工程学设计仍然限制了它的适用性。本研究旨在提出一种优化的、部分自动化的 EndoStitch，并比较传统的 EndoStitch 与优化的、部分自动化的 EndoStitch 在缝合速度和精度方面的差异。
在 EndoStitch 的基础上，开发了一种部分自动化的缝合工具。借助一个由按钮触发的直流电机，仅用一根手指即可进行缝合操作。使用部分自动化的缝合操作器，20 名不同腹腔镜经验水平的外科医生使用传统和部分自动化的缝合操作器成功完成了 10 针的连续缝合。在此之前，每位参与者都接受了 1 分钟的指导和 1 分钟的训练。测量了绝对缝合时间和缝线准确性。使用标准化问卷测试了自动化 EndoStitch 在操作方面的质量。
为了比较两种仪器，我们使用 t 检验比较了缝合的准确性和时间。在这 20 名有腹腔镜经验的外科医生中（少于 5 次腹腔镜干预的有 9 名，少于 20 次腹腔镜干预的有 7 名，多于 20 次腹腔镜干预的有 4 名），两种测试系统在缝合准确性方面没有显著差异。然而，Autostitch 的缝合时间明显更短（P=0.01）。考虑到外科医生的腹腔镜经验，准确性和速度的差异没有统计学意义。Autostitch 的重量和尺寸以及其电缆受到了批评，但舒适的手柄、自动换针和符合人体工程学的操作得到了积极评价。
在微创手术中，部分自动化缝合在操作速度和人体工程学方面具有优势。该领域的持续研究必须集中在最小化、在机器人系统中的实施以及新操作方法（NOTES）的开发上。
