Single-Center Results of Colorectal Procedures Performed with Fully Articulated Laparoscopic Artisential® Devices

Introduction: The ArtiSential® line of products from LivsMed (Seongnam, Republic of Korea) are fully articulated hand-held laparoscopic instruments, possessing end-effectors that closely imitate those of surgical robots with regard to shape and dexterity. Feasibility and safety studies describing the initial experiences with these devices in upper and lower gastrointestinal as well as thoracic surgery have been published. This report presents the outcomes of the largest cohort to date of colorectal procedures performed with Artisential® instruments in a single center. Materials and Methods: Between September 2020 and May 2022, prospective data were collected from patients undergoing ArtiSential®-assisted laparoscopic surgery. A retrospective data analysis was performed for all patients who underwent ArtiSential®-assisted surgery for colorectal indication. Indications for colorectal surgery included rectal and colon cancer, complicated diverticular disease, inflammatory bowel disease, obstructed defecation syndrome, endoscopically nonresectable adenomas and chronic anastomotic fistula following a low anterior resection (LAR). Results: A total of 73 patients (49 males, 24 females) underwent Artisential®-assisted colorectal surgery. The median age of the patients was 62 years (range 34-88) and the median body mass index (BMI) was 27 kg/m2 (range 19-51). Indications for surgery were colorectal malignancy (n=55, 75%), complicated diverticular disease (n=11, 15%), obstructed defecation syndrome (n=3, 4.1%), inflammatory bowel disease (n=2, 2.7%), endoscopically nonresectable adenomas (n=1, 1.4%) and chronic anastomotic fistula following LAR (n=1, 1.4%). The median operative time was 240 minutes (range 95-458). There were no conversions to standard straight-stick laparoscopy or to laparotomy, and no intraoperative complications. All patients who were operated upon for colorectal malignancy had an adequate oncological resection (R0=100%). The median length of stay was 7 days (range 3-36). The overall complication rate was 10.9 % (Clavien-Dindo II: 1 patient, Clavien-Dindo IIIb: 7 patients). There were two readmissions, one unrelated, and no mortalities. Conclusions: This larger series confirms the results of previous reports on the safety and feasibility of Artisential® use in complex laparoscopic colorectal surgery. To examine potential benefits in outcome, comparative studies involving Artisential®, robotic-assisted and standard laparoscopic surgery are needed.