Initial experiences of a novel self-retaining intracorporeal retractor device for urologic laparoendoscopic single-site surgery

Deployable Tubular Mechanisms Integrated with Magnetic Anchoring and Guidance System

Deployable mechanism has received more attention in the medical field due to its simple structure, dexterity, and flexibility. Meanwhile, the advantages of the Magnetic Anchoring and Guidance System (MAGS) are further highlighted by the fact that the operators can remotely control the corresponding active and passive magnetic parts in vivo. Additionally, MAGS allows the untethered manipulation of intracorporeal devices. However, the conventional instruments in MAGS are normally rigid, compact, and less flexible. Therefore, to solve this problem, four novel deployable tubular mechanisms, Design 1 (Omega-shape mechanism), Design 2 (Fulcrum-shape mechanism), Design 3 (Archway-shape mechanism), and Design 4 (Scissor-shape mechanism) in this paper, are proposed integrated with MAGS to realize the laser steering capability. Firstly, this paper introduces the motion mechanism of the four designs and analyzes the motion characterization of each structure through simulation studies. Further, the prototypes of four designs are fabricated using tubular structures with embedded magnets. The actuation success rate, the workspace characterization, the force generation and the load capability of four mechanisms are tested and analyzed based on experiments. Then, the demonstration of direct laser steering via macro setup shows that the four mechanisms can realize the laser steering capability within the error of 0.6 cm. Finally, the feasibility of indirect laser steering via a macro-mini setup is proven. Therefore, such exploration demonstrates that the application of the deployable tubular mechanisms integrated with MAGS towards in vivo treatment is promising.

Modified marionette technique for uniportal video-assisted thoracic surgery: a case report

Background

The current state of thoracoscopic technology allows less invasive surgical procedures and requires fewer ports and incisions. Totally video-assisted thoracic surgery with a single port has emerged as the least invasive thoracoscopic approach.

However, uniportal video-assisted thoracic surgery brings about considerable difficulties, necessitating the development of skillful techniques as well as specific surgical devices. In such situations as dense pleural adhesion and anatomical abnormality, it may be more burdensome, necessitating the conversion to conventional multiportal video-assisted thoracic surgery or even to thoracotomy. To troubleshoot these situations, we herein propose the use of additional technique which could support to sustain the confident operative field for uniportal video-assisted thoracic surgery. This procedure also provides the same cosmetic outcomes as uniportal video-assisted thoracic surgery.

Case presentation

A previously healthy, 77-year-old female was referred to our hospital, with a lung adenocarcinoma measuring 28 mm in the right upper lobe. Uniportal video-assisted thoracoscopic surgery was planned to resect the tumor. During operation, we found the incomplete interlobar fissure between the upper and the middle lobe and the abnormal lobulation of the upper lobe. Therefore, the modified marionette technique was introduced to make the procedure safer and easier. This technique proposed herein consists of employing the untethered gripping forceps to retract the lung, not requiring additional traumatic trocars. The postoperative course was uneventful and the patient `was discharged in 1 week after a modified uniportal video-assisted thoracic surgery for the right upper lobectomy.

Conclusions

The modified marionette technique produced sufficient operative views to attain uniportal video-assisted thoracic surgery safely in this case, rendering operative conversion unnecessary.

Clinical Usefulness of a Self-Retaining Internal Organ Retractor for Laparoendoscopic Single-Site Adrenalectomy

INTRODUCTION

Although laparoendoscopic single-site adrenalectomy (LESS-A) is feasible, it is still considered as a challenging procedure because of technical limitations. Making an optimal retraction is one of major obstacles in LESS-A, and it sometimes requires additional ports or needlescopic devices. Internal organ retractor (IOR) is a novel retraction device that is applied intracorporeally without additional port. In this study, we investigated the clinical usefulness of IOR in LESS-A.

MATERIALS AND METHODS

Medical records of 73 consecutive patients who underwent LESS-A from March 2009 to December 2014 were reviewed. Twenty-two patients underwent LESS-A with IOR and 51 patients without IOR.

RESULTS

Mean age, body mass index, tumor size, operation time, estimated blood loss, and hospital stay were not significantly different between two groups. In IOR group, median number of applied IOR was 2.0 (1.0-3.0) per single operation. Mean time for application and removal was 80.0 and 46.5 seconds for a single IOR, respectively. There were no complications related to the IOR. In without IOR group, there were nine cases that needed needlescopic trocars, six cases that needed 5 mm or larger trocars, and one case that was converted to hand-assisted laparoscopy. However, we did not use any needlescopic instrument or additional trocar in IOR group. There was no case of open conversion in both groups.

CONCLUSION

LESS-A could be done effectively and safely using IOR. IOR system maintained optimal retraction throughout the operation. Its application and removal are intuitive and take only a few minutes. We think IOR system is an attractive retraction method in LESS-A.