Clinical experience with the AutoLap™ image-guided robotic laparoscope positioning system has confirmed high surgeon satisfaction with its usability, as concluded from 129 procedures around the world in various studies.
A component of efficiency in minimally invasive procedures is smooth command and coordination of the laparoscope. Methods of laparoscope control include robotic surgical systems and assistant-held cameras. With assistant-held cameras, the surgeon has no direct control over viewing directions; the image is often unstable because of fatigue or tremor; and speed of movement may be inappropriate as the surgeon works, losing the focal point of interest. These parameters may unintentionally complicate the procedure and prolong it.
The AutoLap™ image-based robotic laparoscope positioning system addresses these issues, affording usability advantages such as continuous image stability and efficiency in performing procedures. These parameters, among others, were examined in a series of clinical studies.
AutoLap™ is indicated for general laparoscopic, gynecologic and urologic procedures. FDA-cleared and CE marked, AutoLap™ is already being used in clinical practice in operating rooms in Europe and the United States. The system is currently in the process of registration for marketing in China.
How it works: Powered by MST’s image-analysis software, AutoLap™ software interprets the surgeon’s instrument movements to guide the robotic laparoscope positioner in real time, offering the surgeon full and natural control of the surgical procedure. The image-guided system uses a screen overlay interface and disposable wireless user interface allowing seamless movement of the laparoscope to follow the surgical instrument within the surgical cavity (VIDEO).
Clinical Experience with AutoLap™
Clinical use of the AutoLap™ system was assessed in a series of multicenter studies starting in January 2013.
These cases, assessing the safety and performance of the system, included 129 laparoscopic procedures that were performed with the AutoLap™ system in the United States, the Netherlands, UK, Italy, Israel and Hong Kong. The procedures were performed in 9 different centers overall and by 20 different surgeons.
The AutoLap™ system was used in general laparoscopic procedures (cholecystectomies, Nissen fundoplications, colectomies, hiatal hernia surgeries, sleeve gastrostomies), and gynecological procedures (excision of endometriosis and adnexal surgery). While an objective evaluation of AutoLap™ performance included measures such as system set-up time and surgical procedure duration, surgeon satisfaction was measured based on subjective evaluations of the system’s usability.
Safety, Performance and Usability Evaluation
The surgeons participating in these cases used the AutoLap™ system to hold and position the laparoscope in all 129 procedures, and all procedures were completed successfully.
Questionnaires were completed postoperatively by the surgeons for subjective evaluation of usability, specifically relating to handling, image stability, effort, satisfaction and the efficiency to perform each procedure with the AutoLap™ system. Answers were given on a scale of 1 (disagree completely) to 5 (agree completely ‒ the most positive response). The results of the usability questionnaires established high satisfaction by each of the surgeons with a median score of 4. All surgeons noted outstanding image stability provided by the system, the advantage of being in control of the field of view, natural to use and a short learning curve.
Of the total procedures, 19 were performed as solo surgery (laparoscopic cholecystectomies, Nissen fundoplications, right hemicolectomies and sigmoid resections). This underscores the high usability of MST’s AutoLap and, moreover, points toward significant cost savings, being performed in the presence of a scrubbed and circulated nurse only, and without a surgical assistant holding the camera. This data is notably supported by previous studies showing that a robotic arm could safely be used to perform solo-surgery laparoscopic procedures, ultimately reducing costs    .
Additional Evaluated Parameters
These case studies also examined the number of times that the laparoscope was removed for cleaning, set up time and procedure time. All parameters received positive feedback overall. Mean system set-up time was relatively short ‒ under five minutes; the laparoscope was removed for cleaning not more than once in most procedures; and procedure times were in line with those commonly reported in literature relating to the same procedures performed with human assistants.
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Conclusion: Usability for Exceptional Surgeon Control
AutoLap™ by MST is the only image-guided robotic laparoscope positioning system that works alongside the surgeon. Image-guided control eliminates some of the most significant challenges of current surgical robotic systems that rely upon the surgeon’s control of the laparoscope. The system enables the surgeon to fully control the camera, controlling the desired field of view, achieving steady and reliable camera movement and a stable laparoscopic image. The active laparoscopic positioner can assume the task of surgical assistant, whose experience and skills are variable; and in various procedures AutoLap™ can facilitate solo surgery.
With extensive clinical experience showing high surgeon satisfaction, AutoLap™ is expected to provide an exceptional user experience and efficient workflow for surgeons seeking to focus on complex procedures without distraction.
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