Laparoendoscopic single site (LESS) in vivo suturing using a magnetic anchoring and guidance system (mags) camera in a porcine model: Impact on ergonomics and workload

Objective: To compare the ergonomics and workload of the surgeon during single-site suturing while using the magnetic anchoring and guidance system (MAGS) camera vs a conventional laparoscope. Methods: Seven urologic surgeons were enrolled and divided into an expert group (n = 2) and a novice group (n = 5) according to their laparoendoscopic single-site (LESS) experience. Each surgeon performed 2 conventional LESS and 2 MAGS camera-assisted LESS vesicostomy closures in a porcine model. A Likert scale (scoring 1-5) questionnaire assessing workload, ergonomics, technical difficulty, visualization, and needle handling, as well as a validated National Aeronautics and Space Administration Task Load Index (NASA-TLX) questionnaire were used to evaluate the tasks and workloads. Results: MAGS LESS suturing was universally favored by expert and novice surgeons compared with conventional LESS in workload (3.4 vs 4.2), ergonomics (3.4 vs 4.4), technical challenge (3.3 vs 4.3), visualization (2.4 vs 3.3), and needle handling (3.1 vs 3.9 respectively; P <.05 for all categories). Surgeon NASA-TLX assessments found MAGS LESS suturing significantly decreased the workload in physical demand (P =.004), temporal demand (P =.017), and effort (P =.006). External instrument clashing was significantly reduced in MAGS LESS suturing (P <.001). The total operative time of MAGS LESS suturing was comparable to that of conventional LESS (P =.89). Conclusion: MAGS camera technology significantly decreased surgeon workload and improved ergonomics. Nevertheless, LESS suturing and knot tying remains a challenging task that requires training, regardless of which camera is used.