Sherman G Wong, MD1, Isabelle Chumfong, MD2, Romain Roux, MTM2, Sachin Rangarajan, MTM2, Chethanya Eleswarpu, MTM2, Austin Jordan, MTM2, Michael Velez, MTM2, Sarah Umetsu, MD2, Insoo Suh, MD2. 1McMaster University, 2University of California, San Francisco
Modern laparoscopic graspers may risk inadvertent injury to tissues, and have been shown to produce crush and puncture injuries. In addition, the force transmitted to the tissues by grasper handles can be highly variable, dependent on the orientation and amount of tissue engaged by the grasper. We have developed a novel vacuum-based laparoscopic grasper designed to reduce tissue injury from grasping. The aim of this study is to compare the incidence and severity of tissue trauma caused by vacuum-based graspers versus standard compressive graspers while manipulating tissue.
METHODS AND PROCEDURES
We performed an in vivo surgical porcine study to assess gross and histologic tissue injury after grasping trials. Grasping trials were divided equally between two adult porcine models; 43 samples of small bowel were grasped with a standard atraumatic laparoscopic grasper (Aesculap double-action atraumatic wave grasper) and 85 were grasped with our novel vacuum grasper with varying vacuum head designs (45 for head A, 20 each for heads B and C). Following grasping, the porcine model was allowed to dwell for 2 hours prior to harvest. Gross injury was graded as follows: 1) no injury, 2) ecchymosis only, 3) serosal injury, 4) seromuscular injury, and 5) perforation. Histologic injury was graded as follows: 1) serositis, 2) partial-thickness injury to the muscularis propria (MP), 3) full-thickness MP injury, and 4) full-thickness MP and mucosal injury. Mann-Whitney U test was performed to compare both gross and histologic injury scores between the groups.
On gross assessment, no samples were noted to have injury more severe than ecchymoses following grasping. The vacuum grasper was found to cause more ecchymosis (median = 2) than the compressive laparoscopic grasper (med. = 1, U = 2591, p < 0.001).
On histologic assessment, the compressive grasper caused significantly more severe injury (med. = 3) compared to the vacuum grasper (med. = 2, U = 1355, p = 0.008). Subgroup analysis showed that heads A (med. = 2, U = 741.5, p = 0.04) and B (med. = 2, U = 558, p = 0.047) caused significantly less injury compared to the compressive grasper. Head C (med. = 2, U = 311.5, p = 0.065) also showed less injury but did not reach statistical significance.
This study demonstrates that our novel laparoscopic vacuum grasper produces less tissue trauma than standard compressive graspers. Vacuum-based grasping is a viable alterative for reducing inadvertent tissue injury in laparoscopy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 85106
Program Number: P508
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster