Pericardium reconstruction with the starfish heart positioner after extended thymectomy with combined left side pericardium resection

First Experience With the Triolifter, a Novel Device for Organ Fixation Used as a Heart Positioner in Cardiac Surgery

We describe our first experience with the Triolifter (Fuji Systems, Yokohama, Japan) in cardiac surgery. The Triolifter is a less expensive, novel organ fixation device developed as a fixation indenter mainly for traction of the lung under video-assisted surgery and is now available in Japan. An 84-year-old man diagnosed with unstable angina pectoris underwent emergency coronary artery bypass grafting (CABG) under cardiac arrest. Following the declamping of the aorta and the resumption of the beating heart, bleeding from the left anterior descending artery (LAD) anastomosis site was observed. The Triolifter was used as a heart positioner to expose the anastomosis site for hemostasis in the setting of an on-pump beating heart. Hemostasis of the posterior descending artery (PDA) anastomosis site could also be confirmed by traction of the right ventricular anterior wall using the Triolifter. It could be effectively and safely used with neither significant subepicardial hematoma nor epicardial injury. In Japan, the Triolifter might be used as one of the insurance-covered devices in off-pump CABG in the future, but globally, it could also be used in on-pump CABG without hesitation because it is so inexpensive.

Development and In Vitro Assessment of a Novel Vacuum-Based Tissue-Holding Device for Laparoscopic and Robotic Kidney Cancer Operations

Simple Summary

Depending on the location and configuration of renal tumors, it is sometimes difficult to grasp, excise, and properly remove them. We have designed and developed a device to improve robotic laparoscopic partial nephrectomy. We tested the device on porcine kidneys and livers and embalmed human cadavers. A preliminary evaluation of this surgical tool showed satisfactory device setup, suction, and tissue handling characteristics.

Abstract

In this paper, we describe the development and evaluation of a novel tissue-holding device (THD) for use during robotic-assisted laparoscopic partial nephrectomy. The THD is a vacuum-based apparatus made of either 3D-printed polyethylene or stainless steel. The proximal end connects to suction tubing routed outside the body, while the distal end is conically shaped and designed to firmly interface with the tumor. Device feasibility studies were performed on six porcine kidneys, two porcine livers, and two embalmed human cadavers. A Likert-scale rating was used to assess device setup, suction, and tissue handling. Additional tests were performed using the daVinci Xi® robotic system. Finally, the holding force of the THD was assessed using different standard vacuum systems and pressure settings. In porcine tissue, the device setup, tissue suction, and handling were rated as “good”. THD insertion and removal was uncomplicated. In a simulated transabdominal approach on fixed human cadavers, the device setup, suction, and tissue handling were also rated as “good”. No macroscopic tissue compromise or device deterioration was noted. The handling and holding abilities using the daVinci Xi® robotic system were also rated “good”. The device was able to successfully hold over 300 g of tissue at a suction pressure of −600 mmHg. The preliminary evaluation of the THD demonstrated satisfactory results.

Hydatid cyst of the pericardium mimicking a right atrial myxoma

The hydatid cyst of the pericardium is a rare pathology; its clinical presentation is variable. It can reveal straightaway at the stage of life-threatening complications. Only a few cases of isolated pericardial hydatid cysts have been reported. Echocardiography, computed tomography, and magnetic resonance imaging are important diagnostic tools for the diagnosis of echinococcosis, and surgery remains the treatment of choice. Herein, we report a rare case of pericardial hydatid cyst who presented to our emergency department with complaints of palpitations, chest pain, and shortness of breath.

A novel suction-based lung-stabilizing device for video-assisted thoracoscopic surgical procedures

Video-assisted thoracoscopic surgery (VATS) has become more commonly used in recent years. To provide a sufficient field of view during these procedures, surgeons must manipulate the lung using conventional devices such as cotton-tipped medical applicators and graspers. However, medical applicators are unable to pull on the target lung lobes, and graspers can damage the lung tissue. We developed a novel suction-based lung-stabilizing silicon device to easily and safely manipulate the lung in order to provide an optimal view during VATS procedures. Here, we describe the use of this device to successfully perform VATS lobectomy in a clinical setting.

Development of a novel lung-stabilizing device for VATS procedures

BACKGROUND

The use of video-assisted thoracoscopic surgery (VATS) has substantially increased in recent years. These procedures involve the insertion of specialized devices into the thoracic cavity via access ports. However, conventional devices such as cotton-tipped applicators and graspers can limit the field of view and injure the fragile lung tissue. The aim of this study was to develop a novel lung-stabilizing device for VATS that provides a good surgical field of view without causing lung injury.

METHODS

We developed a novel suction-based lung-stabilizing device equipped with three hemispheric 20-mm-diameter silicon suction cups. The utility and safety of the novel device were evaluated using a resected pig lung and canine models. In order to assess potential organ damage arising from the use of the novel device, canine lung parenchyma and pleura were macroscopically and microscopically examined after the device had been continuously applied under negative pressure conditions of -400 or -540 mmHg for 1 h.

RESULTS

To assess the utility of the novel device, we performed lobectomies in the resected pig lung and VATS in canine models. The device demonstrated sufficient power to stabilize the lungs and provided a clear field of view during surgery, which enabled us to perform VATS lobectomies more easily than conventional stabilizing forceps. Assessment of the dogs' lungs immediately after detaching the suction-based device revealed no complications such as hemorrhage, air leaks, and bullae formation. Pathological examination after 7 days also showed no substantial damage, except for a small impression in the parenchyma and pleura of the surface layer where the device had contacted the lung tissue.

CONCLUSIONS

Although further validation studies in clinical settings are required, our study indicates that the novel lung-stabilizing device has potentially useful applications in VATS procedures.