Javier Carrillo Silva, MD, Roberto Tapia Espriu, Eng. General Hospital “Dr. Miguel Silva”
1. Objective of the technology or device
In laparoscopy or robotic surgeries, it is required to pull different organs with clamps introduced by multiple wounds, each could complicate with infection or greater post-surgical pain. An adjustable pressure surgical clamp with releasable remote manipulator was designed to hold the organ and pull it by different means, like sutures or external magnets to avoid making more incisions.
2. Description of the technology and method of its use or application
This surgical clamp provides autonomous adjustable pressure and placement with a releasable remote manipulator. Two jaws move simultaneously with respect to the main body of the clamp to open and close to secure or release tissue and/or organs. The instrument is made up of two separable components; a remote manipulator component, and a releasable adjustable pressure clamp component. The United States patent application was published on December 20, 2018 (US 2018/0360458 A1). There are several distal ends of the clamp, such as the Babcock type for traction of viscera such as the appendix or stomach, grasper for the gallbladder, Satinsky for vessels or common bile duct. In laparoscopic appendicectomy we use this clamp to hold and pull it with an external magnet, thereby using only two trocars, a 10mm as a working port and 5 mm as a vision port.
3. Preliminary results
Our first preliminary study is based on a cohort of 20 patients selected in a non-randomized manner with a surgical indication for laparoscopic appendectomy. The groups did not differ for age, gender, operative time, bleeding, phase of appendicitis, postoperative pain (VAS) or the probability of seroma. There was a tendency for the BMI of the group with 2 trocars to be greater than that of 3 trocars (24.8 ± 2.8 vs 22.1 ± 2.3 kg / m2 respectively, p = 0.075 U of Mann-Whitney). Similarly, the group with 2 trocars had a significantly shorter in-hospital stay than in which 3 trocars were used (22.9 ± 10.6 vs. 48 ± 25.9 hours respectively, p = 0.017 U of Mann Whitney). The use of two trocars is feasible and it did not add major risk to the procedure. More studies in different surgical procedures are yet to come.
4. Conclusions / future directions
The use of this clamp is not only feasible but safe according to the descriptively demonstrated in this cohort. This clamp has similar traction as traditional clamps since its distal end can be changed. The distal end may be manipulated by external magnets or sutures. It is possible to reduce the number of incisions, better esthetic results and fewer complications such as less pain, surgical infections risk, ileus, and shorter in-hospital stay. We demonstrated that laparoscopic appendicectomy can be done with two trocars using our clamp. This clamp can be introduced in several laparoscopic procedures including robotic surgery. Studies with a larger number of patients and in different procedures are required to evaluate the final impact.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 98748
Program Number: ETP774
Presentation Session: Emerging Technology Poster Session (Non CME)
Presentation Type: Poster
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