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A Novel Clip Applier: Percutaneous 3 mm Shaft, Longer Effective Length, Bigger Opening, Locking Mechanism and Atraumatic Closure.

Jonathan B Yuval, MD1, Pablo Omelanczuk, MD2, Santiago Horgan, MD3, Ronit Brodie, PAC1, Gad Marom, MD1, Adrian Paz, MD4, Yehuda Bachar4, Yoav Mintz, MD1. 1Hadassah-Hebrew University Medical Center, 2Hospital Italiano de Mendoza, 3University of California San Diego, 4ClipTip Medical

Objective: The trend towards mini-laparoscopy and scarless surgery is gaining acceptance. More instruments are developed to enable this approach. The rationale of mini-laparoscopy is to decrease the incidence of wound related complications like bleeding, infection, trocar site hernia, pain and scarring. The limiting factor of instrument diameter is the size of the end effector, hence inserting large clips through small percutaneous incisions is problematic. Our objective was to develop a percutaneous clip applier containing clips larger than standard, with a wide opening and a locking mechanism.

Description of the technology and method of its use or application: The Secure® 3mm clip applier has a 3mm shaft that is inserted percutaneously in a “Veress-like” technique. It contains 10 clips, which have an effective length of 11 mm (standard medium large clip have 7-8 mm effective length). The opening of the clip is larger than all available clips on the market, and the closure is secured by a locking mechanism. A novel spring like mechanism ensures atraumatic tightness of closure when clipping small and large vessels ranging from 1-10 mm diameter. 

Preliminary Results: Bench top studies were performed to assure appropriate mechanical strength. The device was compared to commercially available clip appliers. Follwing these tests live animal studies were successfully performed in a porcine model. Following IRB approval a first in man study was performed on 7 patients undergoing laparoscopic cholecystectomy. All surgeries in animals and patients were completed without any device related malfunction.

Conclusions / future directions: Minimizing incision length in minimally invasive surgery is a growing trend. Instruments like the 3 mm clip applier are necessary to enable this approach. The clip herein described is only one necessary and missing tool developed for mini-laparoscopy. More novel instruments, specifically 3mm energy instruments should also be developed.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 91162

Program Number: ETP892

Presentation Session: Emerging Technology iPoster Session (Non CME)

Presentation Type: Poster

51

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