Design: Internally controlled prospective cohort/case series.

Setting: Dorsal lithotomy position.

Patients or Participants: Two patients undergoing laparoscopic sacrocolpopexy.

Interventions: A power analysis determined that 16 knots in each group was required to find a difference of 20 seconds with power of 80% and alpha of 5%. During sacrocolpopexy mesh fixation to the anterior and posterior vagina, half of the knots were tied with 2 conventional laparoscopic needle drivers, while the other half were tied with an Artisential needle driver in one hand and a conventional laparoscopic needle driver in the other. The knots were placed by the same surgeon and placed next to each other to avoid any biases related to knot laterality and depth in the pelvis. Each knot consisted of a surgeon’s knot followed by 2 square knots. All cases were recorded and evaluated by 2 reviewers, using time stamps to determine knot tying duration. T-tests compared times between the groups.

Measurements and Main Results: A total of 32 knots were performed during 2 laparoscopic sacrocolpopexies. For the primary outcome, mean time was 119 seconds (SD 43) with the conventional instruments and 66 seconds (SD 14) with the Arisential needle driver (p<0.01). All knot tying components were performed faster with the Artisential needle driver compared to conventional instruments (all p values <0.05).

Conclusion: The Artisential multi-degree of freedom laparoscopic instrument nearly halved the time required for knot tying during laparoscopic sacrocolpopexy compared to conventional laparoscopic instruments. This novel instrument has potential benefits for improving surgical efficiency in minimally invasive surgery.