Hugo Bonatti. University of Maryland Shore Health
Objectives: The minigrasper is a 2.4mm instrument, which is inserted into the abdominal cavity without use of a Trocar. The device is currently more commonly used by gynecologists, however, some experience in general laparoscopic surgery is available. However, it is usually used as an additional retractor. We herein report a series of cases, where the minigrasper is used to completely replace a 5mm instrument.
Methods: From June 2015 to December 2016, the minigrasper (90% with pistol grip) was used in 59 laparoscopic procedures including 30 cholecystectomies, 19 appendectomies, 5 inguinal hernia repairs, 2 ventral hernia repairs and 3 exploratory laparoscopies/lysis of adhesions.
Results: In the vast majority of cases a 5mm first entry port was used in the left upper quadrant and another 5mm or 10-12mm trocar is placed into the umbilicus. Whenever possible, preexisting scars were used. All except two cholecystectomies were done with a 3 instrument technique (2 ports plus minigrasper) with the minigrasper being placed between the two trocars. The series includes eight cases of acute cholecystectomy. For the majority of appendectomies the minigrasper was placed in the midline in the suprapubic area. In 84% the procedure was done with only two 5mm ports and a minigrasper and vascular pedicle and appendix were secured with an endoloop. For inguinal hernia repair a modified transperitoneal technique was developed with creation of the peritoneal flaps from a midline incision from below the umbilicus to the bladder dome instead of a transverse incision. In all cases a ProGrip MESH was used. The peritoneal flap was reattached with absorbable tacks or with a V-lock running suture. The minigrasper can replace a Maryland grasper during intracorporeal suturing. Cosmetic results were excellent and patient satisfaction was high in this series.
Conclusions: The minigrasper can completely replace a 5mm instrument in many commonly performed laparoscopic procedures including cholecystectomy, appendectomy and hernia repair. Obesity does limit its usefulness. When running the small bowel, care must be taken not to cause serosal injuries with the rather sharp instrument and mesentery instead of bowel should be grasped. Placement of ports and the mingrasper need to be individualized for each case.