DEFLECTABLE ENDOSCOPIC INSTRUMENT SYSTEM DENIS

Background: The degrees of intraoperative movement with rigid standard instruments during laparo-endoscopic surgery are limited to translati on, rotation, and pivoting within the insertion point. Additional dist al angulation and rotation of the instrument jaws are a potential impr ovement. Methods: Different types of articulated instruments have been developed and tested in phantom and animal experiments. The final pro totype was used on 30 patients during laparoscopic surgery following a standardized test protocol. Results: The final design incorporates el astically linked tubular segments, 0-120 degrees variable curvature, a nd +/-360 degrees rotation of the jaws element. All functions can be o perated with one hand. Testing on phantom and in laparoscopic surgery showed improved handling of organs and tissue with no complications. C onclusion: We were able to demonstrate the feasibility of the technica l design and the clinical applicability of a deflectable endoscopic in strument system. Although our initial results indicate an improvement in laparoscopic tissue manipulation, the current deflection and jaw ro tation require further technical refinement.