44. Mechanical articulating instruments

Standard laparoscopic instruments have limited dexterity due to their rigidity, making some surgical tasks extremely challenging. Robotic surgery was developed to overcome these issues, but it is associated with high costs. In recent years, many companies have designed and produced hand-held articulating instruments for laparoscopic surgery, to improve dexterity and ergonomics but with greater cost effectiveness. This chapter describes the main commercially available handheld mechanically articulating instruments for minimally invasive surgery, with a focus on the technology, advantages, and disadvantages of each device. These instruments have different designs and mechanisms to achieve higher degrees of freedom.