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 ¤  Abstract
 ¤ Introduction
 ¤ Proof of Concept
 ¤ Conclusion
 ¤  References
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 Table of Contents     
INSTRUMENTS AND EQUIPMENTS
Year : 2018  |  Volume : 14  |  Issue : 1  |  Page : 83-86
 

A novel prototype 3/5 laparoscopic needle driver: A validation study with conventional laparoscopic needle driver


1 Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
2 Department of Biomedical Engineering, Shreeji Surgicals, Mumbai, Maharashtra, India

Date of Submission03-Sep-2016
Date of Acceptance20-Feb-2017
Date of Web Publication11-Dec-2017

Correspondence Address:
Dr. Arvind P Ganpule
Department of Urology, Muljibhai Patel Urological Hospital, Nadiad - 387 001, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmas.JMAS_191_16

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 ¤ Abstract 

Introduction: The challenges in laparoscopic suturing include need to expertise to suture. Laparoscopic needle holder is a” key” instrument to accomplish this arduous task.
Instrument: The objective of this new invention was to develop a laparoscopic needle holder which would be adapted to avoid any wobble (with a shaft diameter same as a 5mm port), ensure accurate and dexterous suturing not just in adult patients but pediatric patients alike (with a short shaft diameter) and finally ensure seamless throw of knots with a narrow tip configuration.
Validation: We did an initial evaluation to evaluate the validity of the prototype needle holder and its impact on laparoscopic suturing skills by experienced laparoscopic surgeons and novice laparoscopic Surgeons. Both the groups of surgeons performed two tasks. The first task was to grasp the needle and position it in an angle deemed ideal for suturing. The second task was to pass suture through two fixed points and make a single square knot. At the end of the tasks each participant was asked to complete a 5- point Likert's scale questionnaire (8 items; 4 items of handling and 4 items of suturing) rating each needle holder. In expert group, the mean time to complete task 1 was shorter with prototype 3/5 laparoscopic needle holder (11.8 sec Vs 20.8 sec). The mean time to complete task 2 was also shorter with prototype 3/5 laparoscopic needle holder (103.2 sec Vs 153.2 sec). In novice group, mean time to complete both the task was shorter with prototype 3/5 laparoscopic needle holder.
Conclusion: The expert laparoscopic surgeons as well as novice laparoscopic surgeons performed laparoscopic suturing faster and with more ease while using the prototype 3/5 laparoscopic needle holder.


Keywords: Laparoscopy, needle holder, validation study


How to cite this article:
Ganpule AP, Deshmukh CS, Joshi T. A novel prototype 3/5 laparoscopic needle driver: A validation study with conventional laparoscopic needle driver. J Min Access Surg 2018;14:83-6

How to cite this URL:
Ganpule AP, Deshmukh CS, Joshi T. A novel prototype 3/5 laparoscopic needle driver: A validation study with conventional laparoscopic needle driver. J Min Access Surg [serial online] 2018 [cited 2020 Aug 9];14:83-6. Available from: http://www.journalofmas.com/text.asp?2018/14/1/83/212017



 ¤ Introduction Top


Suturing is the most critical step in any laparoscopic procedure. The challenges include need to develop the expertise to suture in a narrow closed milieu in a two-dimensional vision.[1] Laparoscopic needle holder is a 'key' instrument to accomplish this arduous task.

Most of the currently available needle holders have the same needle driver 'shaft' diameter as that of the needle driver 'tip'. The needle holders although available in a number of shaft sizes, the most common ones available are 5 mm shaft diameter. Since all the laparoscopic needle holders are supposed to be a Type 1 lever meaning, half of the needle shaft of the laparoscopic needle holder should always lies outside the body while the other half remains inside. This is relevant, in paediatric patients as an excess length of the needle shaft remaining extracorporeal magnifies the tremors at the tip of the instrument.

The factors which contribute to stability and accurate suturing in laparoscopy are:-

  1. Shaft size (the shaft size, if is the same as that of the port, the physiological tremors are less magnified)
  2. Profile of the tip of the needle holder (the tip of the needle holder should be smooth, the knot thrown tends to get entangled if the tip is not smooth)
  3. Diameter and circumference of the port (the smaller the size of the port greater the stability).


We describe a needle holder which aims to overcome the above-mentioned limitations.

Specifications of 'prototype 3/5 laparoscopic needle holder

A need arose for developing new laparoscopic needle holder which will address the above-stated limitations of the existing laparoscopic needle holder.

The objective of this new invention was to develop a laparoscopic needle holder which would be adapted to avoid any wobble of the laparoscopic needle during the laparoscopic surgical procedure (with a shaft diameter same as a 5 mm port), ensure accurate and dexterous suturing not just in adult patients but paediatric patients alike (with a short shaft diameter) and finally ensure seamless throw of knots with a narrow tip configuration [Figure 1].
Figure 1: (a) Schematic drawing of the prototype laparoscopic needle holder. (b) The importance of weld at the tip of the needle holder holder. This helps in avoiding screws at the tip and hence makes knot throwing seamless

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The technical specification of the 'prototype 3/5 laparoscopic needle holder' comprised of two cannula or cylindrical tubes of different diameter coaxially joined, wherein a portion of the length of the cannula housing the jaws of the needle holder had a smaller diameter (3 mm) and was welded within the cannula of large diameter (5 mm) constituting the rest of the needle holder shaft. Outer diameter of the needle shaft is fixed same as the internal diameter of a 5 mm laparoscopic port, so when the needle holder is inserted into the abdomen through the 5 mm laparoscopic port it provides structural stability to the needle shaft as well as the needle holder hence preventing any wobbling of the needle holder within the port. This in turn makes the suturing more accurate and precise [Figure 1] and [Figure 2]. We feel the weld has helped us in avoiding screws at the tip [Figure 1]. The positioning of the screws in conventional needle holders makes knot throwing cumbersome.
Figure 2: (a) The difference in the diameter of the shaft and the tip of the needle holder, the unique feature of this needle holder. (b and c) Intraoperative picture during laparoscopic pyeloplasty of prototype 3/5 laparoscopic needle holder, the needle holding capability of prototype 3/5 laparoscopic needle holder. (d) The narrow tip and weld at the 'tip' allows seamless throw of knots

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To address the limitations encountered during paediatric laparoscopic surgeries, the prototype 3/5 laparoscopic needle holder had a shaft length shorter. This modification results in a shorter length of the shaft remaining outside the abdomen in relation to the shaft length remaining inside. This brings the fulcrum of the lever more towards the centre and not just balances the lever dynamics but also reduces the magnification of movements as experienced with a conventional needle holder.


 ¤ Proof of Concept Top


We did an initial evaluation to evaluate the validity of the prototype 3/5 laparoscopic needle holder and its impact on laparoscopic suturing skills by experienced laparoscopic surgeons and novice laparoscopic surgeons. Five expert laparoscopic surgeons (with more than 30 laparoscopic procedures experience) and five novice surgeons (junior residents undergoing laparoscopic training) were given a set of two fixed tasks to be performed on laparoscopic box trainer [Table 1]. At the end of the tasks, each participant was asked to complete a five-point Likert's scale questionnaire (8 items; 4 items of handling and four items of suturing) rating each needle holder [Table 2]. Standard statistical analysis was carried out using Student's t-test for testing the means of two (conventional needle holder vs. prototype 3/5 laparoscopic needle holder) groups. In [Table 2], for item 1 to item 8, the mean score was calculated for each participant. The software used for carrying this analysis was SPSS version 15.0. (IBM Corporations, New York, USA).
Table 1: Surgeon's task assessment

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Table 2: Subjective questionnaire score

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In expert group, the mean time to complete Task 1 was shorter with prototype 3/5 laparoscopic needle holder (11.8 s vs. 20.8 s). The mean time to complete Task 2 was also shorter with 3/5 needle holder (103.2 s vs. 153.2 s). In novice group, mean time to complete both the tasks was shorter with prototype 3/5 needle holder [Table 1]. The results in the novice group suggest that the prototype 3/5 laparoscopic needle holder does help in decreasing the learning curve while training in the basic steps of intracorporeal suturing.

On subjective scale too, the prototype 3/5 laparoscopic needle holder fared better than conventional needle holder in terms of handling as well as the ease of suturing [Table 2].

The basic steps of intracorporeal suturing are perfect righting of the needle, precise 100% locking of needle and making of 'C' and reverse 'C' loops. Although the first two steps have been assessed objectively in Task 1 (i.e., to grasp the needle and position it in an angle deemed ideal for suturing) the third step (making of 'C' and reverse 'C' loops) of suturing has not been assessed objectively. But subjectively, we feel that the design of prototype 3/5 laparoscopic needle holder contributes in decreasing the stress of suturing during all the above-mentioned steps. The absence of objective evaluation of this step of intracorporeal suturing is a drawback of our study and requires further studies.


 ¤ Conclusion Top


The expert laparoscopic surgeons, as well as novice laparoscopic surgeons, performed laparoscopic suturing faster and with more ease, while using the prototype 3/5 mm laparoscopic needle holder.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 ¤ References Top

1.
Harprit Singh, Arvind Ganpule, Vineet Malhotra, T. Manohar, V. Muthu, and Mahesh Desai. Transperitoneal Laparoscopic Pyeloplasty in Children. J Endourol 2008;21:1461-6.  Back to cited text no. 1
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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