Appraisal of a Novel Atraumatic Retractor for Laparoscopic Surgery

Conor O’Shea1, Emmet Andrews, MD2, Micheal O Riordain, MD3, Padraig Cantillon-Murphy1. 1University College Cork, 2Cork University Hospital, 3Mercy University Hospital

Introduction: This study aims to appraise the benefit and usability of a novel, atraumatic retractor in minimally invasive surgery. The retractor, SecuRetract, may be introduced into the peritoneal cavity through a 5mm trocar, curved to create a hooking profile and inflated to create a soft cushioned interface. The most common method used to retract the bowel involves placing the patient in a steep head-down position known as the Trendelenburg position (TP) and using bowel graspers to manipulate the bowel. Prolonged TP significantly increases the risk of intraoperative complications especially in obese, elderly, or debilitated patients. Furthermore, the small tips on the bowel graspers can generate high pressures locally on the soft tissue, which may lead to injury or perforation. SecuRetract has the potential to ease surgical procedures by providing dynamic, atraumatic control over bowel retraction enhancing operational access as well as improving patient outcomes.

SecuRetract atraumatic laparoscopic retractor in the deflated and actuated position

 

Methods and Procedures: SecuRetract was presented to 24 surgeons across multiple specialities who were surveyed for utility and clinical benefit of SecuRetract in practice. The survey sought to identify what if any additional laparoscopic procedures SecuRetract may be applicable to, the potential frequency of use, and any further feedback on design and functionality.

Results: 92% of colorectal surgeons would use SecuRetract pending further clinical results. Two surgeons did not see a clinical benefit from SecuRetract. However both were open surgeons and do not perform laparoscopic procedures. 85% would use SecuRetract at least once every 2 weeks. Colectomy (95%) and rectal surgery (73%) are the most immediate applications but a much broader spectrum of potential clinical indications were cited to include (e.g. bariatric 37%, gastrectomy 23% and splenectomy 18%). The congress identified 16 surgeons who were willing to champion the technology as early adopters. This direction corresponds to Key Opinion Leaders feedback in Ireland and the US which suggests that SecuRetract is best utilised in lower abdominal laparoscopic surgery.

End-user survey results for device utility

Conclusions: One on one interviews with 24 colorectal surgeons identified a clear appetite and clinical need for a minimally invasive retractor. Attributes which were cited as providing most value were the large curved and inflatable profile at the active distal end, and the small external profile when deflated to facilitate access through a 5 mm instrument port. A more detailed usability assessment is required to comprehensively assess functional feasibility. However initial survey results point to a promising disclosure warranting further exploration.

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