{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T22:44:33Z","timestamp":1773269073541,"version":"3.50.1"},"reference-count":17,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2021,4,6]],"date-time":"2021-04-06T00:00:00Z","timestamp":1617667200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,4,6]],"date-time":"2021-04-06T00:00:00Z","timestamp":1617667200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Endosc"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>The laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair is a widely performed minimally invasive operation, but can present considerable ergonomic challenges for the surgeon. Our objective was to determine if a novel handheld software-driven laparoscopic articulating needle driver can mitigate these difficulties.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>The video recordings of a consecutive series of TAPP cases by a single surgeon using the articulating device were compared with a series of cases using straight-stick laparoscopy. Two critical steps of the procedure were analyzed for time: mesh fixation and peritoneal suture closure. These steps were then compared before and after 10 initial consecutive cases to analyze whether the surgeon demonstrated improvement. A cost analysis was also performed between the two techniques.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>For mesh fixation, the surgeon averaged 227\u00a0s using tacker devices, compared with 462.4\u00a0s using the novel laparoscopic device (<jats:italic>p<\/jats:italic>\u2009=\u20090.06). For the peritoneal closure component of the operation, the surgeon improved the time per suture pass during closure from 60.61\u00a0s during the first 10 cases to 38.84\u00a0s after the first 10 cases (<jats:italic>p<\/jats:italic>\u2009=\u20090.0004), which was comparable to the time per stitch for standard laparoscopy (34.8\u00a0s vs 34.84\u00a0s, <jats:italic>p<\/jats:italic>\u2009=\u20090.997). Left-sided inguinal hernia repairs using the articulating device demonstrated a significantly longer time per stitch during peritoneal closure compared to the right side after first 10 cases (left: 40.62\u00a0s; right: 27.91, <jats:italic>p<\/jats:italic>\u2009=\u20090.005). Our direct cost analysis demonstrated that suture closure of the peritoneum using the articulating device was more cost-effective than tack fixation.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>After only a 10 case initial experience, a laparoscopic hand-held articulating needle driver is comparable to standard laparoscopy to complete suture mesh fixation and peritoneal closure for TAPP inguinal hernia repair. Further, the feasibility of suture mesh fixation minimizes the need for costly tacker devices. This instrument appears to be a promising tool in this largely minimally invasive era of hernia repair.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00464-021-08446-6","type":"journal-article","created":{"date-parts":[[2021,4,6]],"date-time":"2021-04-06T21:02:58Z","timestamp":1617742978000},"page":"3221-3231","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Initial experience using a handheld fully articulating software-driven laparoscopic needle driver in TAPP inguinal hernia repair"],"prefix":"10.1007","volume":"35","author":[{"given":"Victoria","family":"Needham","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diego","family":"Camacho","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Flavio","family":"Malcher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,4,6]]},"reference":[{"key":"8446_CR1","first-page":"75","volume-title":"New Horizons in Laparoscopic Surgery","author":"FM Sanchez-Margallo","year":"2018","unstructured":"Sanchez-Margallo FM, Szold A (2018) Handheld Devices for Laparoscopic Sugery. In: Ferhatoglu MF (ed) New Horizons in Laparoscopic Surgery. IntechOpen, London, pp 75\u201393"},{"key":"8446_CR2","unstructured":"Xtensions, Human. Cision PR Newswire (2018) Human Xtensions receives FDA clearance for its HandX, the first in a line of smart digital handtop solutions. https:\/\/www.prnewswire.com\/news-releases\/human-xtensions-receives-fda-clearance-for-its-handx-the-first-in-a-line-of-smart-digital-handtop-solutions-677636573.html. Accessed 28 Jun 2020"},{"key":"8446_CR3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s10029-017-1668-x","volume":"22","author":"The HerniaSurge Group","year":"2018","unstructured":"The HerniaSurge Group (2018) International guidelines for groin hernia management. Hernia 22:1\u2013165","journal-title":"Hernia"},{"key":"8446_CR4","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1007\/s00464-018-6322-x","volume":"33","author":"JV Vu","year":"2019","unstructured":"Vu JV, Gunaseelan V, Krapohl GL, Englesbe MJ, Campbell DA Jr, Dimick JB, Telem DA (2019) Surgeon utilization of minimally invasive techniques for inguinal hernia repair: a population-based study. Surg Endosc 33:486\u2013493","journal-title":"Surg Endosc"},{"key":"8446_CR5","doi-asserted-by":"publisher","first-page":"155","DOI":"10.4103\/0972-9941.27730","volume":"2","author":"R Bittner","year":"2006","unstructured":"Bittner R, Leibl BJ, Jager C, Kraft B, Ulrich M, Schwarz J (2006) TAPP-stuttgart technique and result of a large single center series. J Min Access Surg 2:155\u2013159","journal-title":"J Min Access Surg"},{"key":"8446_CR6","unstructured":"Human Xtensions (2016) HandX instructions for use. 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