Novel Dynamic Retractor: Advancing Minimally Invasive Surgery by Reducing Ports

Kurt Roberts, MD

Yale University

Providing visibility and access with Retraction is of the upmost importance in laparoscopic surgery. Typically 1 or 2 ports are designated for graspers or other instruments allowing for traction and counter-traction. Reduced port surgery, single incision (SILS) , robotic and natural orifice surgery (NOTES) are clear evidence towards an interest in advancing surgery by reducing incisions and ports. The challenge is that each of these approaches require a considerable change in surgical technique and therefore can have a steep learning curve, or may be less desirable. The objective of this innovative device was to accomplish the goal of reducing ports and minimizing incisions, without requiring a change in surgical technique. With this innovative dynamic retraction device, regardless of the approach: SILS, Robotics, NOTES or conventional laparoscopic surgery, the surgeon has the opportunity to reduce ports and hands without the need to change surgical technique. They gain increased visibility and dynamic retraction with less instruments and trocar ports.

A 5mm device that inserts a grasper into the abdomen and allows to grasp an organ or tissue atraumatically. This grasper, tethered by a pre-attached suture, is released from the device and then an anchor is deployed laparoscopically into the abdominal wall. The device is then removed out of the abdomen thru the port. The suture threads thru the anchor (that functions as a fulcrum/pulley) in the abdominal wall and comes out through the port. By pulling on the suture outside the body the grasper/organ is pulled towards the anchor within the abdominal wall. By releasing the tension on the suture on the outside of the body the grasped organ/tissue returns to its original position. The grasper and anchor can both easily be repositioned multiple times. Additional graspers and anchors can be deployed for additional retraction. At the end of surgery the device is re-inserted and the anchor/s and grasper/s are easily removed with the device.

Preliminary results:
The device has successfully been used in the animal model for the retraction of gallbladder, appendix, stomach, small bowel, colon, rectum, ovaries and uterus. Additionally the use of 2 and more sutures at the same time were used for traction and counter-traction. As an example it was used for a cholecystectomy with one grasper at the fundus for cephalad retraction and a grasper at the infundibulum for lateral/medial retraction. Instruments and camera are passed next to the suture thru the port without any difficulties. The dynamic retraction used allowed the reduction of ports in all cases.

This innovative dynamic retractor allows active retraction of organs and tissue thru a port that is used for the camera or other instruments. It therefore eliminates ports and incisions that are usually used for laparoscopic retraction. The ease of use and the ability to reduce ports and incisions will be available for use in humans in reduced port, single port, robotic and natural orifice surgery within the next few months.

Session: Poster Presentation

Program Number: ETP072

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