University of Bern, Spital Interlaken, Unterseen, Switzerland.
, Stockhornweg 15, 3422, Kirchberg, Switzerland.
Surg Endosc. 2017 Oct;31(10):4298-4308. doi: 10.1007/s00464-017-5438-8. Epub 2017 Mar 9.
The Kymerax© Precision-Drive Articulating Surgical System by Terumo© is a handheld laparoscopic robot which permits motion in two additional degrees of freedom (deflection and rotation in the instrument tip). In a pelvitrainer model, we compared the performance of participants with different laparoscopic experiences and compared Kymerax© to conventional laparoscopic instruments.
20 expert surgeons, performing more than 50 laparoscopic procedures per year, and 25 medical students without any experience in surgery at all were selected. Each participant was randomized into two groups: Group TK performed the tasks using the traditional laparoscopic Instruments (TLI) first and Kymerax© thereafter, group KT vice versa. Six standardized tasks were used: Two instructional exercises and four tasks where time, number of mistakes, and overall precision were measured. Finally, a questionnaire had to be answered.
All four tasks were performed significantly more slowly with the Kymerax© device. Improved needle control in stitches towards the surgeon, significantly less deviation while cutting along different lines as well as a significantly reduced fraying of the cutting edge were found when participants were using Kymerax©. By questionnaire more than 90% of the participants indicated clear advantages using Kymerax©. However, participants needed more training time and had an earlier loss of concentration with Kymerax©. Further complaints about Kymerax© were its limitations in rotation and deflection, the impaired view as well as the non-ergonomic instrument handle. Rotation force, instrument weight, digital instrument-tip control, and needle fixation were rated as accurate.
This study shows that more time is needed to solve tasks with Kymerax© compared to conventional laparoscopic instruments. Kymerax© is superior to conventional laparoscopy for suturing at difficult angles and cutting along complex structures. Kymerax© can potentially bring benefits for certain laparoscopic tasks, but as seen in this study, further developments are necessary. Terumo© meanwhile closed down its Kymerax
特鲁姆（Terumo）的 Kymerax© 精密驱动关节手术系统是一种手持腹腔镜机器人，它允许在两个附加自由度上运动（器械尖端的偏转和旋转）。在骨盆训练器模型中，我们比较了具有不同腹腔镜经验的参与者的表现，并将 Kymerax© 与传统腹腔镜器械进行了比较。
选择了 20 名经验丰富的外科医生，每年进行超过 50 例腹腔镜手术，以及 25 名完全没有手术经验的医学生。每位参与者都被随机分为两组：TK 组先使用传统腹腔镜器械（TLI）完成任务，然后使用 Kymerax©；KT 组反之。使用了六个标准化任务：两个指导练习和四个任务，测量时间、错误次数和整体精度。最后，参与者还需要回答一份问卷。
所有四项任务使用 Kymerax© 设备时都明显变慢。当参与者使用 Kymerax© 时，发现缝合时对向外科医生的针控制得到改善，沿不同线切割时的偏差明显减少，以及切割边缘的磨损明显减少。通过问卷，超过 90%的参与者表示使用 Kymerax© 有明显优势。然而，参与者使用 Kymerax© 时需要更多的培训时间，并且较早地失去了注意力。进一步对 Kymerax© 的投诉包括其在旋转和偏转方面的限制、视觉受损以及非人体工程学的器械手柄。旋转力、器械重量、数字器械尖端控制和针固定被评为准确。
这项研究表明，与传统腹腔镜器械相比，使用 Kymerax© 解决任务需要更多的时间。Kymerax© 在缝合困难角度和沿复杂结构切割方面优于传统腹腔镜。Kymerax© 可能会为某些腹腔镜任务带来好处，但正如本研究所见，还需要进一步的发展。特鲁姆（Terumo）随后关闭了 Kymerax©
