Use of a novel multi-purpose sponge for laparoscopic surgery: Does it have special relevance to robotically-assisted laparoscopic surgery?

Background: The Star System (Ekymed S.p.A.) is a novel multipurpose sponge developed for conventional manual laparoscopic surgery. Materials and Methods: Between December 2012 and December 2014 we successfully used the sponge in ten robot-assisted and ten direct manual laparoscopic operations to achieve hemostasis, for blunt dissections, for atraumatic lifting of solid organs, to check for bile leaks, for cleaning the surgical field thus avoiding frequent use of suction or the application of hemostatic agents. The reason of the insertion (RI), the main use (MU) and any further use (FU), once inserted, were registered for each operation and compared between the two groups. Results: The principal RI was hemostasis for minor bleeding, without differences between the two groups (P=NS). Regard to MU, in the robotic group cleaning the surgical field was utilized more than laparoscopic group (100% versus 60%; p=0.03). About FU, atraumatic solid organs lifting was more frequent during robotically assisted surgery than with laparoscopy (50% versus 0%; p=0.01). A statistically more frequent use of the sponge was registered during standard laparoscopy for the blunt dissection (30% versus 80%; p=0.03). Conclusions: The Star System was beneficial in both approaches, but it imparts added benefit during robotically-assisted laparoscopic surgery organs because of the lack of tactile feedback and because the operating surgeon is remote from the patient, and has to rely on the assisting surgeon in the sterile field for dealing with bleeding episodes, cleansing/ mopping the operative field when necessary, who may not be experienced or completely proficient.