A crossover study on the advantage of an additional rotation function in a needle holder compared to a conventional needle holder in a pelvitrainer model

Tibor Andrea Zwimpfer, Bernhard Fellmann-Fischer, Robert Oehler, Andreas Schötzau, André B. Kind


Background: Needle-loading is the most challenging step in laparoscopic suturing. The rotational needle holder (RNH) is a handheld laparoscopic instrument, which increases the degree of freedom relative to the needle by the rotation of the instrument’s tip. By moving the jaws of the needle holder with a clamped needle a rotational movement is achieved, which allows the needle to be adjusted. The aim of this study was to compare the RNH with the conventional needle holder (CNH) in a pelvitrainer model.
Methods: Twenty medical students with no prior laparoscopic experience performed four standardized exercises. The participants were randomly divided into two groups. Group RC performed the suture exercises using the RNH first and the CNH thereafter. Group CR performed these tasks in the reverse sequence. The number of errors, precision, and time taken were measured. After each task, the students had to answer specific questions about the methods used.
Results: The 270-degree angle task was performed with significantly fewer mistakes (P=0.003) and more rapidly using the RNH in the second period (P=0.008). The students performed the 180-degree angle task more rapidly during the second run, regardless of which technique was used (P=0.042). Neither of the other two tasks showed any significant difference. The precision was very good overall, and in all four tasks it was superior when the rotational method was used, although no significant difference was observed. The students made more mistakes when using the CNH. The questionnaire confirmed a clear advantage for the RNH, but the participants expressed concerns about its counterintuitive handling.
Conclusions: The advantages of the RNH were only partially confirmed. For some angles, the rotational function was beneficial. However, this value was decreased for participants with greater experience and superior laparoscopic skills. More intuitive control of the rotation function may potentially offer an advantage in terms of speed and may be associated with a steeper learning curve.