Optimizing Surgical Tools for Single-Site Surgery: A Cadaver-Based Design Study

Background: Laparoendoscopic single site surgery (LESS) is feasible for more complex procedure types, but the technical challenges and learning curve posed by LESS makes traditional multi-incision laparoscopy still the preferred technique. The aims of this study were to understand the restricted mobility and positional requirements of these more complex procedures and to generate innovative instrument designs to overcome these restrictions. Methods: A two-phase study was conducted where three lightly-embalmed (fresh tissue) cadavers were utilized to estimate in vivo mobility restriction and positional requirements. These data were combined to quantifying instrument force and positional requirements to develop a novel design for a LESS-specific grasper. Results: The LESS-specific has an ergonomic curved axial handle and locking mechanism that enables surgeons to relax their grip without the grasper releasing. Conclusion: Further design adaptations are needed to optimize the size, angles, and curvature of the tool, as well as to add two points of articulation for rapid intracorporeal adjustment.