Comparing a Mechanical Analogue With the Da Vinci User Interface: Suturing at Challenging Angles

The da Vinci Surgical System offers a natural user interface and wrist articulation, which enable suturing and other complex surgical actions in confined spaces. However, both the one-time cost of the system and the recurring cost of the limited-use instruments remain high. This has motivated the development of several hand-held alternatives-some partially motorized, some fully mechanical-in recent years. While a few of these have been commercialized, none have yet met with broad commercial success comparable to the da Vinci robot. In this letter, we suggest a user interface-based explanation for this, and describe a new mechanical instrument that provides wrist articulation with a novel user interface. We provide results of a single-user pilot study with an experienced laparoscopic surgeon to compare the new device with a traditional wristless laparoscopic tool, a prior commercial wristed mechanical tool (the RealHand), and the da Vinci robot, in the context of suturing at challenging angles. We observe better targeting of desired suture needle entry and exit points with the new device in comparison to prior wristed and wristless mechanical instruments, with the da Vinci only slightly outperforming the new tool.