Page 3 - WALS Journal

World Journal of Laparoscopic Surgery, May-August 2008;1(2):1-5
Comparison of PMAT Camera Holder with Human Camera Holder
Comparison of PMAT Camera Holder with

Human Camera Holder

3
1 RK Mishra, D Lorias, A Minor
2
1 Director and Laparoscopic Surgeon, Laparoscopy Hospital, New Delhi, India
2 CINVESTAV IPN Electrical Department, Mexico DF
3 CINVESTAV IPN Electrical Department, Mexico DF

Abstract In laparoscopic surgery, the operating surgeon does not have
Aim: During minimal access surgery an assistant is controlling the direct visual control of the operative field. The surgeon depends
laparoscope and surgeon should be free to manipulate instruments. on the camera assistant to maneuver the camera for optimum
Although the advantages of laparoscopic surgery are well documented, visualization of laparoscopic target of dissection. In only
3-6
one disadvantage is that, for optimum performance, an experienced advanced units and hospital the laparoscopic team can afford
camera driver is required who can provide the necessary views for the to use an experienced camera assistant, elsewhere this is not
operating surgeon. There are many drawbacks in human camera economically feasible on a regular basis. This difficulty and
operator especially if they are not trained. The self camera-control by helplessness of surgeon is compounded by the fact that
the surgeon gives more stability of the laparoscopic image. The aim of cooperation must occur on a real-time basis with each step and
this study was to compare PMAT camera holder device with traditional
assistant-driven laparoscopic camera control. camera person should be adequately trained in laparoscopy.
As such, independent driver bias arises where conflicts of
Materials and Methods: Laparoscopic Appendicectomy, Ovarian cooperation and skill can occur in which the surgeon’s optimum
Cystectomy and Laparoscopic sterilization were performed. On 14 view is somewhat hampered by the camera driver’s perception.
patients, the operating surgeon used the “PMAT” and performed the
surgery without a laparoscopic camera assistant. On the other group Manual camera control can also be physically demanding leading
of 14 patients, an experienced camera operator was responsible for to fatigue and a suboptimum visual field when the camera
control of the laparoscopic field of vision in the traditional manner. operator is exhausted. During prolonged procedures frustration
The time required for surgery was documented. and conflicts can occur between camera operator and surgeon.
Very often an equally experienced camera driver is required as
Results: The mean operative times for PMAT and camera person-
assisted appendicectomy was 45 minutes and 40 minutes respectively. the surgeon to facilitate necessary views for the operating
For ovarian cystectomy 45 and 50 minutes and for laparoscopic laparoscopic surgeon. Ideally, the surgeon should have full
sterilization it was 15 and 10 minutes. There were no differences in control of all instruments required that are directly required for
outcome of surgery or blood loss in the two groups. The operative conducting a given minimal access surgical procedure. This
surgeon perceived some increase in shoulder and neck pain with use of includes surgical operative instruments and control of the
the PMAT scope holder. operative field. The purpose of non-human motorized camera
Conclusions: This PMAT device provides a means for the operative holders is to facilitate camera-control to the surgeon and to
surgeon to safely perform simple laparoscopic procedures alone without stabilize the visual field during minimally invasive procedures.
significantly increasing operative time or morbidity. Recently many such, active and passive camera holders have
been developed everywhere in the world to offer the surgeon
Keywords: Laparoscopic surgery, Robotic Surgery, Device Camera, an alternative and better tool for control of the operating
EndoAssist, Camera holder.
7,8
surgeon. The advantages of non-human camera operator
include:
INTRODUCTION
• Elimination of the fatigue of the assistant who holds the
In the current era of evidence based medicine enthusiasm for camera.
laparoscopic surgery is rapidly gaining momentum. There is an • Elimination of fine motor tremor and small inaccurate
immense amount of literature showing advantages of minimal movements.
access surgery and acceptance by almost all the surgical • Delivery of a steady and tremor-free image.
1,2
speciality. The advantages of laparoscopic surgery are well • Non-dependency on camera operator.
documented but there are significant challenges not only to the • Reduced cost of surgery.
operating surgeon but also to the person who holds laparoscope. • Reduced number of highly skilled staff.

1