The impact of guided instrument insertion during laparoscopy: a randomized study with novices in an optical box trainer

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During laparoscopic operations, the trocars are often out of the viewing field of the laparoscope. Blind insertion of laparoscopic instruments is potentially dangerous especially when they are pointed or hot. A guidance of the instrument to the target point has the potential to improve the safety of instrument insertion.


In this study, the effect of a mechanical and an optical tool for guided instrument insertion into the abdominal cave was evaluated. The controlled prospective randomized study measured safety and efficiency of instrument insertion by 60 novices in an inanimate standardized box trainer. A post-test questionnaire based on the NASA Task Load Index prompted for the subjective impressions of the subjects.


Instrument insertion with optical guidance showed a shorter (p = 0.002) insertion time (median 87.5 s for nine insertions) compared with blind insertion (median 112.0 s for nine insertions). The error number with optical guidance (median 0.5) was lower (p = 0.064) compared with blind insertion (median 1.0). The mechanical guidance showed a shorter (p = 0.001) insertion time (median 89.0 s for nine insertions) and less (p = 0.044) touch errors (median 0) compared with blind insertion. The results of the two guidance tools (mechanical vs. optical guidance) showed no significant difference. In the questionnaire, 89% of the novices subjectively judged the mechanical guidance tool better than blind insertion. The assessments of optical compared to mechanical guidance turned out quite similar.


In the experimental setup, instrument insertion with a guidance tool performed faster and safer compared with blind insertion. The subjective assessments confirmed the benefit of instrument guidance.

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We gratefully acknowledge the implementation of two line laser modules to achieve laser cross-functionality by Patrick Haas and the suggestion of a “mechanical” guidance tool by PhD Sebastian Halder (TWT). We are also very thankful for the statistical support of the Institute for Clinical Epidemiology and Applied Biometry (Tübingen University).


The Panorama-Camera project is funded by the German Federal Ministry of Economics and Technology. Grant Number: KF2171006LW3

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Correspondence to Andreas Kirschniak.

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W. Kunert, C. Land, M. Braun, J. Reichold, A. Kirschniak and C. Falch had and have no conflicts of interest or financial ties to disclose.

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Kunert, W., Land, C., Braun, M. et al. The impact of guided instrument insertion during laparoscopy: a randomized study with novices in an optical box trainer. Surg Endosc 34, 787–795 (2020) doi:10.1007/s00464-019-06829-4

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  • Laparoscopic surgery
  • Laser guide
  • Trocar with laser
  • Instrument insertion
  • Randomized controlled trial
  • Experimental setup