Magnetically anchored camera and percutaneous instruments maintain triangulation and improve cosmesis compared with single-site and conventional laparoscopic cholecystectomy

Background This study evaluated operative outcomes and ergonomics for a magnetic camera (MAGS) used in conjunction with percutaneous instruments [percutaneous surgical set (PSS)] compared with single-site laparoscopic (SSL) and conventional laparoscopic (LAP) cholecystectomy techniques. Methods Four surgical trainees each performed three porcine cholecystectomies using three randomized techniques including MAGS/PSS, SSL, and LAP. The operative outcomes, procedure-specific ratings (1-5 scale; 1 = superior), workload (1-10 scale; 1 = superior), and global impressions (1-10 scale; 10 = superior) were recorded. Comparisons used analysis of variance (ANOVA) on ranks (Kruskal-Wallis), and p values lower than 0.05 were considered significant. Results The operative outcomes were similar except for significantly higher blood loss with SSL (16.3 +/- 10.3) versus LAP (2.8 +/- 1.5; p < 0.05) but not with MAGS/PSS (4.8 +/- 3.8). Several inadvertent tissue-damaging events occurred with SSL but not with MAGS/PSS or LAP. The incision was significantly shorter with MAGS/PSS (29.3 +/- 2.8 mm) and SSL (29.3 +/- 2.5 mm) than with LAP (48.0 +/- 3.6 mm; p < 0.05). Compared with SSL (3.6 +/- 0.5), the procedure-specific ratings significantly favored MAGS/PSS (2.8 +/- 0.4) and LAP (1.7 +/- 0.2; p < 0.05). Ergonomics and technical challenges both were rated significantly inferior with SSL (4.3 +/- 1.0 and 3.8 +/- 0.5, respectively) versus LAP (1.5 +/- 0.6 and 2.0 +/- 0.8, respectively; p < 0.05) but not with MAGS/PSS (2.5 +/- 1.0 and 3.0 +/- 0.8, respectively). Both MAGS/PSS (4.5 +/- 0.5) and SSL (4.8 +/- 1.0) were associated with a significantly greater workload than LAP (2.5 +/- 0.6; p < 0.05). Global impression ratings were significantly higher for LAP (8.7 +/- 1.3) versus SSL (5.8 +/- 2.0; p < 0.05) but not for MAGS/PSS (7.1 +/- 1.8). Cosmesis was significantly better with MAGS/PSS (9.5 +/- A 0.6) versus LAP (6.5 +/- 2.4; p < 0.05) but not with SSL (8.8 +/- 1.3). Conclusion The MAGS/PSS technique allows better triangulation and fewer technical difficulties than SSL and better cosmesis than LAP. Further development of these devices is warranted.