Insulation failure in robotic and laparoscopic instrumentation: a prospective evaluation

Area of Science:

• Minimally Invasive Surgery
• Surgical Technology
• Biomedical Engineering

Background:

• Insulation failures (IFs) in surgical instruments pose a risk during minimally invasive procedures.
• Understanding the incidence and prevalence of IFs is crucial for patient safety.
• Both laparoscopic and robotic instruments are widely used, but their comparative risk profiles for IFs require investigation.

Purpose of the Study:

• To determine the incidence, prevalence, and location of insulation failures (IFs) in both laparoscopic and robotic surgical instruments.
• To compare the rates of IFs between robotic and laparoscopic instrumentation.

Main Methods:

• Two testing phases were conducted involving a total of 78 robotic and 298 laparoscopic instruments in Phase A, and 60 robotic and 308 laparoscopic instruments in Phase B.
• Instruments were subjected to specific electrical loads (20 W at 2.64 kV, 1 kV, and 4.2 kV) to assess insulation integrity.
• Data on the prevalence and incidence of IFs were collected and statistically analyzed.

Main Results:

• Phase A revealed a higher prevalence of IFs in robotic instruments (32%) compared to laparoscopic instruments (13%) (P<.05).
• The incidence of IFs after 10 uses was significantly higher in robotic instruments (80%) than in laparoscopic instruments (36%).
• Phase B testing showed IFs in 81.7% of robotic instruments versus 19.5% of laparoscopic instruments (P<.005).

Conclusions:

• There is a high incidence and prevalence of insulation failures in endoscopic instrumentation.
• Robotic surgical instruments demonstrate a significantly greater susceptibility to insulation failures compared to laparoscopic instruments.
• These findings highlight a critical safety concern in robotic surgery that warrants further attention and potential mitigation strategies.