Department of Surgery, Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA.
Albert Einstein College of Medicine, Bronx, NY, USA.
Surg Endosc. 2021 Jun;35(6):3221-3231. doi: 10.1007/s00464-021-08446-6. Epub 2021 Apr 6.
The laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair is a widely performed minimally invasive operation, but can present considerable ergonomic challenges for the surgeon. Our objective was to determine if a novel handheld software-driven laparoscopic articulating needle driver can mitigate these difficulties.
The video recordings of a consecutive series of TAPP cases by a single surgeon using the articulating device were compared with a series of cases using straight-stick laparoscopy. Two critical steps of the procedure were analyzed for time: mesh fixation and peritoneal suture closure. These steps were then compared before and after 10 initial consecutive cases to analyze whether the surgeon demonstrated improvement. A cost analysis was also performed between the two techniques.
For mesh fixation, the surgeon averaged 227 s using tacker devices, compared with 462.4 s using the novel laparoscopic device (p = 0.06). For the peritoneal closure component of the operation, the surgeon improved the time per suture pass during closure from 60.61 s during the first 10 cases to 38.84 s after the first 10 cases (p = 0.0004), which was comparable to the time per stitch for standard laparoscopy (34.8 s vs 34.84 s, p = 0.997). Left-sided inguinal hernia repairs using the articulating device demonstrated a significantly longer time per stitch during peritoneal closure compared to the right side after first 10 cases (left: 40.62 s; right: 27.91, p = 0.005). Our direct cost analysis demonstrated that suture closure of the peritoneum using the articulating device was more cost-effective than tack fixation.
After only a 10 case initial experience, a laparoscopic hand-held articulating needle driver is comparable to standard laparoscopy to complete suture mesh fixation and peritoneal closure for TAPP inguinal hernia repair. Further, the feasibility of suture mesh fixation minimizes the need for costly tacker devices. This instrument appears to be a promising tool in this largely minimally invasive era of hernia repair.
腹腔镜经腹腹膜前（TAPP）腹股沟疝修补术是一种广泛开展的微创手术，但对手术医生来说具有相当大的人体工程学挑战。我们的目的是确定一种新型的手持软件驱动的腹腔镜关节持针器是否可以减轻这些困难。
对一名外科医生使用关节器械进行的一系列连续 TAPP 病例的视频记录与一系列使用直棒腹腔镜的病例进行了比较。分析了手术的两个关键步骤的时间：网片固定和腹膜缝合关闭。然后在 10 例连续病例之前和之后对这些步骤进行比较，以分析外科医生是否有所改善。还对两种技术进行了成本分析。
在网片固定方面，外科医生使用吻合器设备的平均时间为 227 秒，而使用新型腹腔镜器械的时间为 462.4 秒（p=0.06）。在手术的腹膜关闭部分，外科医生在关闭过程中每缝合一次的时间从第 10 例之前的 60.61 秒提高到第 10 例之后的 38.84 秒（p=0.0004），与标准腹腔镜的每缝合一次时间相当（34.8 秒比 34.84 秒，p=0.997）。在第 10 例之后，左侧腹股沟疝使用关节器械的腹膜关闭每缝合一次的时间明显长于右侧（左侧：40.62 秒；右侧：27.91 秒，p=0.005）。我们的直接成本分析表明，使用关节器械缝合关闭腹膜比使用吻合钉固定更具成本效益。
在仅有 10 例初始经验的情况下，腹腔镜手持关节持针器与标准腹腔镜相比，在完成 TAPP 腹股沟疝修补术中的缝合网片固定和腹膜关闭方面具有可比性。此外，缝合网片固定的可行性最大限度地减少了对昂贵吻合钉设备的需求。在这个主要的微创疝修补时代，这种器械似乎是一种很有前途的工具。
