Laparoscopic multifunctional instruments: design and testing of initial prototypes.

BACKGROUND: Advances in minimally invasive surgical techniques will require new types of instrument end-effectors for smaller, longer, and flexible instruments. These include a new class of multifunctional instruments capable of performing more than 1 task with a single set of working jaws. Furthermore, it is desired that multifunctional instruments be designed to provide improved dexterity compared with that in currently commercially available instruments. METHODS: Three prototypes of multifunctional laparoscopic surgical instruments are described: (1) a mechanical scissors-grasper, (2) a mechanical scissors-grasperarticulator, and (3) a compliant mechanism scissors-grasper. Methods of baseline analysis, design methods and considerations, and subjective evaluations of interim prototypes are presented. RESULTS: The 3 prototypes demonstrate promising early results. However, based on subjective evaluation, these prototypes do not perform individual functions as well as basic disposable single-function laparoscopic instruments do. CONCLUSIONS: The concept of multifunctionality and increased end-effector dexterity is achievable as demonstrated by the prototypes presented. Further work is required to refine, simplify, and improve the multifunctional instruments to a point where they may be useful as surgical tools.