Cable Organizer for Laparoscopic and Endoscopic Procedures

Abstract

Background:

During laparoscopic and endoscopic procedures, multiple devices are used simultaneously, requiring preconnection and arrangement of their cables. Traditionally, cables are bundled with gauze and fixed with drape clips, which hinders intraoperative adjustment of cable number and orientation. Thus, an innovative device for more flexible and convenient equipment line management is needed. Commercial cable-management products lack adjustability during surgery; a rotatable, angle-lockable organizer could fulfill this need.

Methods:

We designed a novel surgical cable organizer and produced a prototype via 3-dimensional (3D) printing. It comprises 2 discs: the upper one has 6 pairs of arc-shaped buckles, and the lower one contains adhesive for attachment to surgical drapes. Their opposing serrated surfaces enable rotation or angle locking. We compared the time for surgeons from different specialties to connect and adjust laparoscopic and endoscopic cables using the new device and the traditional gauze method.

Results:

In simulated operations, the cable organizer significantly shortened the time for cable connection (1.46 ± 0.46 vs 4.56 ± 0.72 seconds; P ≤ .001), direction adjustment (1.25 ± 0.21 vs 4.11 ± 0.39 seconds; P ≤ .001) and increasing cable (1.27 ± 0.23 vs 3.51 ± 0.63 seconds; P ≤ .001) versus conventional methods, a benefit attributable to its rotatable, angle-locking dual-disc structure. However, the design needs further optimization and validation of sterilization, biocompatibility and mechanical durability, with wider clinical validation, before clinical use.

Conclusion:

This innovative cable organizer greatly reduces device management time during laparoscopic and endoscopic surgeries, which may enhance operating room efficiency.

INTRODUCTION

Laparoscopes and endoscopes, key tools in minimally invasive surgery, are now standard in urological and gynecological procedures.¹ These operations often require additional devices, such as ultrasonic knives, bipolar electrocoagulators, vacuum extractors, and Ligasure for laparoscopic procedures, and vacuum extractors, flushers, and laser fibers for endoscopic procedures. Consequently, multiple device lines must be connected and arranged prior to surgery. Typically, these lines are bundled with sterile absorbent gauze and secured with a drape tower clip. However, this setup makes it challenging to adjust the number and direction of the lines during surgery. Developing a method to facilitate the adjustment of equipment lines during operations would be highly beneficial.

METHODS

Three-dimensional (3D) printing technology is extensively applied in everyday life, including in the medical field.² By employing advanced computer-aided design (CAD) software,³ we can design a model of a wire organizer that efficiently secures and adjusts device cables. This model is created using 3D printing technology with resin as the material (Figure 1).

Figure 1.

The operation equipment wire organizer 3D-printed model.

To securely fix all cables, we measured the diameter of cables commonly used in laparoscopic and endoscopic operations. The model comprises 2 discs, each with a radius of 40 mm (Figure 2B). The top disc features 6 pairs of circular arc buckles on its surface, while the bottom disc is equipped with adhesive on the back to attach it firmly to a drape. Two pairs of buckles have an inner radius of 7.5 mm, and the other 4 pairs have an inner radius of 2.5 mm (Figure 2A). Figures 2B and 2C detail the spacing and sizes of the buckles. A metal rod with a radius of 1.25-mm runs through the center of the discs, and their contact surface is saw-toothed. The discs can rotate together, allowing for a 30° angle change (Figure 2D).

Figure 2.

The operation equipment wire organizer view in CAD: (A) the main view of the model in CAD; (B) the overhead view of the model in CAD; (C) the left view of the model in CAD; (D) the perspective of the model in CAD.

The 6 pairs of circular arc buckles are symmetrically aligned along the long axis. Two pairs, each with a 7.5-mm inner radius, are positioned on either side of the disc's centerline. These are specifically designed to secure the light source cable for the endoscope, the laparoscope's cable, the flushing tube, and the vacuum aspirator tube. The other 4 pairs, each with a 2.5-mm inner radius, are intended for securing additional equipment.

We invited doctors from various departments, such as urology (n = 12), obstetrics and gynecology (n = 13), and abdominal surgery (n = 15), to participate in a study comparing the efficiency of connecting and adjusting the cables of laparoscopic and endoscopic devices. This process involved adding one cable and adjusting its direction by 180°. Participants used both the wire organizer and the traditional gauze method. Each doctor repeated both methods 3 times, and we recorded the average time taken for each.

Statistical analysis Continuous variables are presented as mean ± standard deviation (SD). Normality was assessed using the Shapiro–Wilk test. Because each surgeon performed both the wire-organizer and the traditional gauze method (paired design), within-subject comparisons between the 2 methods were performed using the paired t test when data were normally distributed, or the Wilcoxon signed-rank test otherwise. The magnitude of time saving (traditional time minus organizer time) was compared among the 3 surgical specialties (urology, obstetrics and gynecology, and abdominal surgery) using one-way analysis of variance (ANOVA) followed by Bonferroni post hoc tests. Mean differences with 95% confidence intervals (CIs) are reported. All analyses were performed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA). A 2-sided P-value ≤ .05 was considered statistically significant. For each task, each surgeon repeated each method 3 times, and the mean of the 3 trials was used for analysis.

This study enrolled eligible patients with laparoscopic or endoscopic operation from the Shanxi Bethune Hospital, China. Recruitment commenced on June 1, 2025 and concluded on September 30, 2025, spanning approximately 5 months. Of 68 patients initially screened, 28 were excluded due to critical condition, eligible participants provided written informed consent and were enrolled in the study. This study was reviewed and approved by the Institutional Review Board and was conducted in accordance with the Declaration of Helsinki.

RESULTS

Patients undergoing endoscopic procedures were positioned in the lithotomy position, with device cables typically draped over both legs (Figure 3A). However, these cables were often inadequately secured, increasing the risk of them falling off. A wire organizer was used to secure the cables centrally in the lower abdominal operation area (Figure 3B). The cables, arranged from left to right, included the plasma electrotome, the flushing tube, the light source, and the monitor.

Figure 3.

The devices’ cables fixed method of laparoscope and endoscopy operations: (A) the cables fixed by traditional way during laparoscope operation; (B) the cables fixed by wire organizer during laparoscope operation; (C) the cables fixed with gauze (indicated by a yellow arrow) in traditional laparoscope operation; (D) the cable fixed by wire organizer during laparoscope operation.

The traditional method of securing laparoscopic device cables with gauze complicated the adjustment of the device's position and direction (Figure 3C). The primary issue was that each adjustment required loosening and refixing the gauze and equipment cables, which increased operation time. In contrast, cables held by the wire organizer were easy to adjust, allowing for both height and directional changes simply by turning the top disc (Figure 3D). The lines in Figure 3D, from left to right, represent the ultrasonic scalpel, the pneumoperitoneum intake tube, the laparoscopic connection line, and the electrocoagulator.

The results indicated that using the wire organizer significantly reduced the time required for connecting, adjusting the direction, and extending the cable compared to the traditional method (Figure 4).

Figure 4.

Time consuming by traditional connecting way and connecting by wire organizer (min). *P < .001 compared with the traditional connecting way (paired t test).

A total of 40 surgeons completed all trials: 12 urologists, 13 obstetrician-gynecologists, and 15 abdominal surgeons. The individual timing data of every participant with each approach are shown in Table 1. Timing data for all 3 tasks were normally distributed (Shapiro–Wilk test, all P ≥ .05); the paired t test was therefore applied. The wire organizer significantly shortened the time required for cable connection compared with the traditional gauze method (1.46 ± 0.46 vs 4.56 ± 0.72 seconds; mean saving 3.11 ± 0.61 seconds, 95% CI 2.91–3.30; t = 32.08; P ≤ .001). It also significantly reduced the time needed for 180° direction adjustment (1.25 ± 0.21 vs 4.11 ± 0.39 seconds; mean saving 2.86 ± 0.46 seconds, 95% CI 2.71–3.00; t = 39.54; P ≤ .001) and for increasing cable (1.27 ± 0.23 vs 3.51 ± 0.63 seconds; mean saving 2.24 ± 0.65 seconds, 95% CI 2.03–2.45; t = 21.73; P ≤ .001). Comparable advantages of the wire organizer were observed within each specialty subgroup (all P ≤ .001). The magnitude of the connection-time saving differed significantly among the 3 specialties (one-way ANOVA, F = 13.04, P ≤ .001), being smaller in urologists (2.52 ± 0.68 seconds) than in obstetrician-gynecologists (3.45 ± 0.46 seconds) and abdominal surgeons (3.28 ± 0.27 seconds; Bonferroni post hoc, P ≤ .001 for both comparisons), whereas the savings for direction adjustment and cable increasing did not differ significantly among specialties (F = 1.20, P = .31; F = 2.21, P = .12, respectively; Table 2). In summary, the wire organizer significantly reduced the time required for connecting, adjusting the direction, and extending the cable compared with the traditional method (Tables 1 and 2; Figure 4).

Table 1.

Individual Timing Data (Minutes; Mean of 3 Trials) for Each Participating Surgeon Using the Traditional Gauze Method and the Wire Organizer

Surgeon	Traditional Conn.	Traditional Dir.	Traditional Inc.	Organizer Conn.	Organizer Dir.	Organizer Inc.
U1	3.69	4.42	3.42	1.46	1.02	2.05
U2	4.42	3.83	4.39	0.97	1.49	1.39
U3	2.85	4.60	4.12	1.31	1.40	1.49
U4	3.39	4.75	3.36	1.52	0.91	1.60
U5	4.28	3.39	4.43	1.07	1.25	1.54
U6	3.29	4.16	4.49	0.95	1.29	1.38
U7	3.52	4.42	3.17	0.90	1.53	1.16
U8	4.20	3.80	4.62	1.48	1.31	1.04
U9	2.81	4.14	4.44	1.32	0.78	1.40
U10	3.51	4.57	3.34	1.14	0.96	1.21
U11	3.76	4.43	3.69	0.74	1.48	1.03
U12	4.31	4.17	3.68	0.90	1.19	1.34
G1	5.20	4.31	2.71	2.41	1.26	1.11
G2	5.04	3.70	2.62	1.41	1.55	1.64
G3	5.52	4.49	2.86	1.47	1.43	0.86
G4	4.98	4.01	2.83	2.45	1.72	0.99
G5	5.28	4.44	3.35	1.85	1.33	1.68
G6	4.85	3.72	3.03	1.65	1.18	1.15
G7	5.43	4.45	3.39	1.57	1.64	1.26
G8	4.94	3.86	3.34	1.31	1.20	1.07
G9	5.45	3.85	3.60	1.65	1.38	1.37
G10	5.10	4.41	3.73	1.21	1.28	1.32
G11	4.79	4.72	4.22	1.14	1.19	1.28
G12	4.63	4.44	4.59	1.24	1.16	1.16
G13	4.20	4.37	4.54	1.20	1.25	1.18
A1	5.32	3.68	2.57	2.50	1.12	1.20
A2	4.88	3.31	2.92	1.76	1.31	1.27
A3	5.27	3.98	2.37	2.15	1.29	1.56
A4	5.20	3.62	3.22	1.86	1.35	1.15
A5	5.33	3.70	2.44	2.29	1.31	1.11
A6	4.99	3.27	2.81	1.97	1.14	1.03
A7	4.84	4.00	3.09	1.67	1.44	1.12
A8	5.03	3.68	3.34	1.73	1.05	1.35
A9	4.50	4.22	3.54	1.21	1.03	1.09
A10	4.53	4.18	3.64	1.41	1.29	1.04
A11	4.44	3.80	3.58	1.08	1.19	1.22
A12	4.78	4.28	3.39	0.90	1.11	1.32
A13	4.67	4.10	3.89	1.30	0.81	1.11
A14	4.57	4.37	3.62	0.91	1.18	1.19
A15	4.71	4.56	3.91	1.17	1.13	1.15

Abbreviations: U, urology; G, obstetrics and gynecology; A, abdominal surgery. Conn., cable connection; Dir., 180° direction adjustment; Inc., increasing cable.

Table 2.

Timing Results and Comparisons between the Traditional Gauze Method and the Wire Organizer (n = 40)

Task	Traditional (Minutes)	Organizer (Minutes)	Time Saving (Minutes)	95% CI (Minutes)	t	P
Connection	4.56 ± 0.72	1.46 ± 0.46	3.11 ± 0.61	2.91–3.30	32.08	<.001
Direction adjustment (180°)	4.11 ± 0.39	1.25 ± 0.21	2.86 ± 0.46	2.71–3.00	39.54	<.001
Increasing cable	3.51 ± 0.63	1.27 ± 0.23	2.24 ± 0.65	2.03–2.45	21.73	<.001

	Time saving by specialty (mean ± SD, minutes):
	Urology (n = 12)	Ob/Gyn (n = 13)	Abdominal (n = 15)	F	P
Connection	2.52 ± 0.68	3.45 ± 0.46	3.28 ± 0.27	13.04	<.001
Direction adjustment	3.01 ± 0.51	2.86 ± 0.41	2.73 ± 0.44	1.20	.31
Increasing cable	2.54 ± 0.64	2.21 ± 0.70	2.03 ± 0.57	2.21	.12

Abbreviation: Ob/Gyn, obstetrics and gynecology. Time saving = traditional time − organizer time. Paired t test, df = 39; one-way ANOVA, df = (2, 37).

DISCUSSION

During laparoscopic and endoscopic surgeries, various devices are essential to ensure smooth operation. As a result, multiple connection wires for equipment, including those for the laparoscopic and endoscopic instruments, are typically organized in the operating area. Before the operation begins, it is crucial to properly connect and secure these device cables while allowing for potential intraoperative adjustments. The effectiveness of cable fixation can significantly influence the procedure's progress the procedure. Currently, there is no literature on standardizing methods for equipment wire fixation. Based on experiences from various medical centers in China, a common practice involves loosely tying the cables of laparoscopic and endoscopic equipment, along with related intraoperative auxiliary devices, using sterile gauze. This gauze is then secured to the edge of the surgical area with towel forceps to provide relative stability for the cables. This method is simple, easy to learn, cost-effective, and requires no additional equipment. However, a drawback is that if additional devices are needed or removed during surgery, the gauze fixation must be loosened and readjusted, which can be time-consuming.

Certain surgical techniques, such as laparoscopic radical nephroureterectomy, may necessitate adjustments in patient positioning. Traditional wire bundle fixation methods cannot modify the cable arrangement direction without completely releasing and refixing them, which increases nonoperative time for patients. To overcome these limitations, we have designed and fabricated a 3D-printed wire organizer that securely fixes each surgical device’s wire harness while allowing convenient adjustments in both device quantity and cable direction during the procedure. As described in this paper, our results show that the wire organizer effectively secures each piece of surgical equipment and significantly reduces the time needed for fixation, wire harness adjustment, and direction alignment compared to traditional methods.

These findings confirm the feasibility and advantages of this novel device for managing surgical equipment wires. However, with ongoing advancements in laparoscopic and endoscopic surgical equipment, especially the recent rise of robot-assisted laparoscopic surgery, further adjustments and optimizations are needed to improve the device's structure. Additionally, validating the device’s feasibility and reliability across a broader range of surgical procedures is essential. The present study has several limitations. First, efficiency was assessed by surgeons in a simulated operating-room setting rather than in actual procedures, and the clinical benefit in real operations remains to be confirmed. Second, only the cable types and diameters currently used in our hospital were tested; compatibility with robotic surgical systems and larger-bore tubing requires validation. Third, the number of participating surgeons, although drawn from 3 specialties, was modest, and a larger multicenter evaluation is warranted.