Enhanced exposure and visualization in splenic flexure mobilization with comparable perioperative outcomes: experience with Artisential® during laparoscopic low anterior resection.

BACKGROUND: For many surgeons performing laparoscopic colectomies, splenic flexure mobilization (SFM) remains one of the most technically challenging phases. To resolve challenges in laparoscopic SFM, we utilized Artisential®, a line of articulated laparoscopic instruments (ALI), to gain more freedom in traction and enlarge the visualized working space. We developed a study to demonstrate how Artisential® allowed for a more efficient usage of surgical space during splenic flexure mobilization without surgical quality. METHODS: This study consisted of two parts. First was a comparative analysis of dead space shown on screen during surgery with and without Artisential® usage. Video recordings of nine consecutive laparoscopic low anterior resections (LAR) performed by a single surgeon using an Artisential® grasper in the left (nondominant) hand were chosen as the experimental group. Among 43 LAR cases performed by the same surgeon in the previous year without the Artisential®, 9 cases most similar to the control were chosen by propensity score matching (PSM) of sex, age, distance from the anal verge, and preoperative chemoradiotherapy status. We compared the two groups in terms of average operation duration, postoperative complication severity, and the number of lymph nodes harvested. RESULTS: Using an Artisential® grasper for traction for splenic flexure mobilization during laparoscopic low anterior resections increased screen visualization by 11.8% compared with using conventional laparoscopic graspers. Length of operation, severity of postoperative complications, and number of harvested lymph nodes were comparable in both modalities. CONCLUSIONS: Angulated traction was utilized for splenic flexure mobilization in laparoscopic low anterior resections using a grasper from Artisential®, a line of articulated laparoscopic instruments. The surgeon was able to create a significantly larger working field and better exposure of target structures. This implementation did not affect operation time, recovery, or specimen integrity.