Comparison Between the PAF Rail and Surgical Instruments for Organ Manipulation in Laparoscopic and Robotic Surgery: A Randomised Cross-Over Usability Study

This study evaluates the usability and workload associated with the pneumatically attachable flexible (PAF) rail, a soft robotic device designed for safer organ manipulation and retraction during robotic-assisted partial nephrectomy (RAPN) and other laparoscopic procedures. Fourteen expert robotic and laparoscopic surgeons performed a simulated surgical retraction task using the PAF rail and standard surgical instruments. Usability was assessed using the System Usability Scale (SUS), and workload was measured with the NASA-TLX. Qualitative feedback was also collected to explore surgeon perceptions, and analysed thematically. Histopathological analysis was conducted to assess tissue integrity following instrument interaction. The PAF rail achieved SUS scores exceeding the good usability threshold, particularly among urology surgeons. However, its use was associated with increased cognitive load and longer task completion times, especially for less experienced surgeons. Histopathological analysis showed no additional tissue damage from the PAF rail compared to existing instruments. This study demonstrates that the PAF rail has potential as a safe and effective method for organ manipulation and retraction, achieving good usability and showing no additional tissue damage compared to existing instruments.