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The EndoHand: comparison with standard laparoscopic instrumentation
S V Jackman1, P A Jarzemski, S M Listopadzki
1Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-2101, USA. sjackman@jhmi.edu
Summary
The novel EndoHand offers greater flexibility and manipulation for laparoscopic surgery but has reduced dexterity and tactile feedback compared to standard tools. It shows promise for assisting surgeons, particularly with tissue positioning.
Area of Science:
- Minimally Invasive Surgery
- Surgical Instrumentation
- Robotics in Medicine
Background:
- Laparoscopic surgery demands instruments that replicate the dexterity and tactile feedback of the human hand.
- Current laparoscopic tools often lack the flexibility and sensory feedback for complex manipulations.
Purpose of the Study:
- To evaluate the performance of the novel EndoHand, a three-fingered laparoscopic instrument, against standard laparoscopic tools.
- To compare grasping ability, manipulation dexterity, and tactile feedback of the EndoHand.
Main Methods:
- The study measured approach angles, dexterity task completion time and errors, and tactile feedback accuracy.
- A pelvic trainer and a custom device simulating tissue resistance were used for experiments.
Main Results:
- The EndoHand demonstrated a wider range of approach angles (35-90 degrees) compared to straight instruments (70-90 degrees).
- Dexterity was significantly lower with the EndoHand (time P=0.0002, errors P=0.02), and tactile feedback accuracy was also reduced (P=0.02).
- Subjective assessment indicated the EndoHand could grasp various objects and perform complex manipulations due to its wrist joint.
Conclusions:
- The EndoHand prototype shows promise for sophisticated manipulation and flexibility in laparoscopic surgery, despite limitations in dexterity and tactile feedback.
- Its potential use may be as an assistive tool on the surgeon's nondominant hand for tissue manipulation and positioning.
- Further clinical trials are necessary to define the EndoHand's role in clinical laparoscopic procedures.