# Bimanual Use of Articulating Laparoscopic Instruments (ArtiSential) in Pediatric Surgery: A Report of Three Cases

## TL;DR

This paper reports on using ArtiSential laparoscopic instruments in three pediatric surgeries, showing they can be a cost-effective alternative to robotic surgery.

## Contribution

The novel use of bimanual ArtiSential instruments in pediatric minimally invasive surgery is introduced as a lower-cost alternative to robotic systems.

## Key findings

- Bimanual ArtiSential use enabled safe and precise procedures in narrow pediatric operative fields.
- All three procedures were completed without complications and with minimal blood loss.
- The articulating instruments allowed stable triangulation and fine manipulation in restricted spaces.

## Abstract

Articulating laparoscopic instruments such as ArtiSential have been developed to overcome the limited range of motion associated with conventional straight instruments, particularly in narrow operative fields. While robot-assisted surgery provides highly precise manipulation, its introduction in pediatric surgery remains limited due to high cost and restricted insurance coverage. We introduced bimanual use of ArtiSential in pediatric minimally invasive surgery as a potential alternative to robotic assistance and evaluated its feasibility and technical advantages.

We performed laparoscopic procedures using bimanual use of ArtiSential instruments in 3 pediatric patients: 2 single-incision laparoscopic appendectomies for chronic appendicitis (10- and 15-year-old patients) and 1 laparoscopic resection of an esophageal bronchogenic cyst with Dor fundoplication (11-year-old patient). In all cases, the procedures were safely completed without intraoperative complications, and blood loss was minimal. The articulating function allowed stable triangulation and fine manipulation even in restricted spaces such as the umbilical single-port approach and the esophagogastric junction. All patients were discharged between postoperative days 3 and 4 with uneventful recovery.

Bimanual use of ArtiSential instruments enabled precise dissection and suturing in narrow pediatric operative fields, suggesting that this approach may serve as a practical, lower-cost alternative to robotic surgery where robotic systems are unavailable or not indicated. Further accumulation of cases is required to assess the learning curve, indications, and long-term outcomes.