Vol.:(0123456789) 1 3 Surg Endosc DOI 10.1007/s00464-017-5957-3 NEW TECHNOLOGY First experience with THE AUTOLAP™ SYSTEM: an image- based robotic camera steering device Paul J. M. Wijsman 1  · Ivo A. M. J. Broeders 1  · Hylke J. Brenkman 2  · Amir Szold 3  · Antonello Forgione 4  · Henk W. R. Schreuder 5  · Esther C. J. Consten 1  · Werner A. Draaisma 1  · Paul M. Verheijen 1  · Jelle P. Ruurda 2  · Yuval Kaufman 6   Received: 1 April 2017 / Accepted: 22 October 2017 © Springer Science+Business Media, LLC 2017 procedural time, accuracy of imaged-based movements, and user satisfaction. Results Surgical procedures were completed with the Auto- Lap™ system in 64 cases (97%). The mean overall setup time of the AutoLap™ system was 4 min (04:08 ± 0.10). Procedure times were not prolonged due to the use of the system when compared to literature average. The reported user satisfaction was 3.85 and 3.96 on a scale of 1 to 5 in two studies. More than 90% of the image-based movements were accurate. No system-related adverse events were recorded while using the system. Conclusion Safe and efficient use of the core technology of the AutoLap™ system was demonstrated with high image stability and good surgeon satisfaction. The results support further clinical studies that will focus on usability, improved ergonomics and additional image-based features. Keywords Robotic · Steering · Camera holder · Laparoscopy · Active camera control systems · Autolap™ Visualization in endoscopic surgery is a challenge for both surgeon and camera assistant. The surgeon highly depends on the camera assistant to provide a stable, centered, and non-rotated image of the target area and has no control other than verbal commands or manual correction, which requires release of one of the instruments. An often encountered pitfall is that the image is unsta- ble due to tremor, unintended movements or rotation of the camera by the surgical assistant. Furthermore, manual con- trol can also be physically demanding leading to fatigue and suboptimal control. Inexperienced or inattentive assistants may displace the camera frequently, make jerky movements, malposition the laparoscope in relation to the horizon, and point the camera outside the focus of interest more often Abstract Background Robotic camera holders for endoscopic sur- gery have been available for 20 years but market penetration is low. The current camera holders are controlled by voice, joystick, eyeball tracking, or head movements, and this type of steering has proven to be successful but excessive disturbance of surgical workflow has blocked widespread introduction. The Autolap™ system (MST, Israel) uses a radically different steering concept based on image analysis. This may improve acceptance by smooth, interactive, and fast steering. These two studies were conducted to prove safe and efficient performance of the core technology. Methods A total of 66 various laparoscopic procedures were performed with the AutoLap™ by nine experienced surgeons, in two multi-center studies; 41 cholecystectomies, 13 fundoplications including hiatal hernia repair, 4 endome- triosis surgeries, 2 inguinal hernia repairs, and 6 (bilateral) salpingo-oophorectomies. The use of the AutoLap™ system was evaluated in terms of safety, image stability, setup and and Other Interventional Techniques * Paul J. M. Wijsman pjm.wijsman@meandermc.nl 1 Deparment of Surgery, Meander Medical Center, Maatweg 3, Amersfoort, The Netherlands 2 Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands 3 Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel 4 Department of Surgery, Niguarda Cà Granda Hospital, Milan, Italy 5 Department of Gynecologic Oncology, UMC Utrecht Cancer Center, Utrecht, The Netherlands 6 Department of Surgery, Assuta Medical Center, Haifa, Israel