ArtiSential® vs. straight-stick in laparoscopic left-sided colorectal resection: a prospective randomized study

This prospective randomized study compared the efficacy of articulated ArtiSential® instruments with that of conventional straight laparoscopic instruments in minimally invasive left-sided colorectal resections. The primary endpoint was conversion to open laparotomy. Secondary endpoints included intraoperative and postoperative complications, estimated blood loss, operating time, lymph node yield, and length of hospital stay.

78 patients (37 males) were randomized to conventional straight instruments (n = 40) or ArtiSential® instruments (n = 38). Categorical variables were analyzed using Chi-square or Fisher's exact tests; continuous variables were analyzed using the 2-sample t-test or Mann-Whitney U test, depending on distribution. Subgroup analysis was performed for rectal resections (n = 22; standard: n = 8, ArtiSential®: n = 14).

In the overall cohort, no significant difference was observed in conversion to open surgery (7.5% vs. 0%; p = 0.241) or secondary endpoints: operating time (median 180.0 vs. 178.0 min; p = 1.000), estimated blood loss (25.0 vs. 20.0 mL; p = 0.096), intraoperative complications (7.5% vs. 2.6%; p = 0.616), postoperative complications (22.5% vs. 23.7%; p = 0.901), hospital stay (5.0 vs. 6.0 days; p = 0.695), and lymph node yield (17.0 vs. 14.0; p = 0.145). In the rectal resection subgroup, ArtiSential® instruments were associated with significantly lower conversion (37.5% vs. 0%; p = 0.036) and reduced blood loss (35.0 vs. 10.0 mL; p = 0.017), with no other significant differences observed.

While no benefit was observed in the overall cohort, articulated ArtiSential® instruments may provide advantages in rectal resections, including lower conversion rates and reduced blood loss, suggesting particular utility in technically challenging minimally invasive procedures.