Jeong Chang Wook, Kim Sung Hoon, Kim Hyung Tae, Jeong Seong Jin, Hong Sung Kyu, Byun Seok-Soo, Lee Sang Eun
1Seoul National University Bundang Hospital, Seongnam, Korea.
Surg Innov. 2013 Oct;20(5):466-70. doi: 10.1177/1553350612468961. Epub 2012 Dec 14.
The current articulating instruments used in laparoendoscopic single-site surgery do not appear to provide the joint forces required. Thus, we measured the joint forces of first-generation articulating laparoscopic instruments. To compare these forces with those necessary in the surgical context, we evaluated the forces sufficient to produce secure surgical ties in an animal model.
The articulating instruments tested were Laparo-Angle (Cambridge Endoscopic Devices Inc, Framingham, MA), RealHand (Novare Surgical Systems Inc, Cupertino, CA), and Roticulator (Covidien Inc, Mansfield, MA). For each, we measured the angle between the end-effector and the shaft in proportion to the articulating force using a push-pull gauge. Two fixed-position configurations of the instruments were predetermined: the neutral and the fully articulated positions. The forces required to secure surgical ties for the ureter, renal artery, and renal vein were evaluated using kidneys harvested from a female pig.
The bending forces required to bend from the neutral position to 30° were 5.6 ± 1.2 and 4.7 ± 1.0 N with the Laparo-Angle and RealHand, respectively. Furthermore, the slippage forces in the fully articulated state were 1.8 ± 0.3, 1.6 ± 0.2, and 1.5 ± 0.2 N in the above order. In contrast, the mean forces to produce surgical ties of the ureter, renal artery, and renal vein were 14.5 ± 2.3, 11.5 ± 0.8, and 10.3 ± 2.3 N, respectively.
The joint forces of first-generation articulating instruments for laparoendoscopic single-site surgery are not sufficient to meet the usual operative needs. Improved articulating instruments with greater articulating forces should be developed.
目前用于腹腔镜单孔手术的关节器械似乎无法提供所需的关节力。因此，我们测量了第一代关节腹腔镜器械的关节力。为了将这些力与手术环境中所需的力进行比较，我们在动物模型中评估了产生牢固手术结扎所需的力。
测试的关节器械有Laparo-Angle（剑桥内窥镜设备公司，马萨诸塞州弗雷明汉）、RealHand（诺瓦雷外科系统公司，加利福尼亚州库比蒂诺）和Roticulator（柯惠医疗公司，马萨诸塞州曼斯菲尔德）。对于每种器械，我们使用推拉力计测量末端执行器与杆身之间的角度与关节力的比例关系。预先确定了器械的两种固定位置配置：中立位置和完全关节运动位置。使用从雌性猪身上摘取的肾脏评估输尿管、肾动脉和肾静脉进行手术结扎所需的力。
Laparo-Angle和RealHand从中立位置弯曲到30°所需的弯曲力分别为5.6±1.2 N和4.7±1.0 N。此外，在完全关节运动状态下的滑动摩擦力按上述顺序分别为1.8±0.3 N、1.6±0.2 N和1.5±0.2 N。相比之下，输尿管、肾动脉和肾静脉进行手术结扎的平均力分别为14.5±2.3 N、11.5±0.8 N和10.3±2.3 N。
第一代用于腹腔镜单孔手术的关节器械的关节力不足以满足通常的手术需求。应开发具有更大关节力的改进型关节器械。
