First Human Experience Using the Dynamic Laparoscopic NovaTract(tm) Retractor. Initial Experience of 18 Patients

Iswanto Sucandy, MD, Andrew J Duffy, MD, FACS, Geoffrey Nadzam, MD, Kurt E Roberts, MD, FACS. Yale University

Objective: The concept of reducing the number of transabdominal access ports has been criticized for violating basic tenets of traditional multiport laparoscopy. The potential benefits of natural orifice translumenal endoscopic surgery, reduced port surgery, and laparoendoscopic single-site surgery include decreased postoperative pain, improved cosmesis, less hernias and fewer wound-related complications. However, the technical challenges associated with these access methods have not been adequately addressed by advancement in instrumentations. We describe our initial experience with the NovaTract™ Laparoscopic Dynamic Retractor (NovaTract Surgical, Inc, Madison, CT).

Methods: A retrospective review of a prospectively maintained database of all patients who underwent two-port laparoscopic cholecystectomy between September 2013 and July 2014 using the NovaTract™ retractor was performed. The patients were equally divided into 3 groups (Group A, B, C) based on the order of case performed, as an effort to evaluate potential learning curve. Statistical analysis was performed using analysis of variance (ANOVA) with p-value <.05 is considered statistically significant.

Results: Eighteen consecutive patients (Female:Male=14:4) underwent successful two-port laparoscopic cholecystectomy with a preoperative diagnosis of symptomatic cholelithiasis. Mean age was 39.9 years (range: 22-72) with mean BMI of 28.1 kg/m2 (range: 21-39.4). All cases were scheduled electively after an appropriate informed consent. The overall mean operative time was 65 minutes (range: 42-105), with Group A 70 minutes, Group B 65 minutes, and Group C 58 minutes (p=.58). All cases were completed laparoscopically without open conversion. There were no intra- or postoperative complications. All patients were discharged on the same day of surgery. Final pathology reports were consistent with cholelithiasis and chronic cholecystitis in all patients. No complications have been noted during postoperative follow-up. All patients have returned to their routine activities within 2 weeks after the cholecystectomy.

Conclusions: The NovaTract™ Laparoscopic Dynamic Retractor appears to have met the initial objectives. It is safe and easy to use with minimal learning curve, reflected by standard operative time for a laparocopic cholecystectomy using only two ports. It allows surgical approach to mimic the conventional laparoscopic technique, while reducing the number of dedicated retraction ports.

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