Hidenori Fujii, MD, PhD, Yoshiyuki Kawakami, MD, PhD. Japanese Red Cross Fukui Hospital
Objective of the device
The concept of reduced-port surgery (RPS) is gaining widespread acceptance, and devices needed to hold organs in the abdominal cavity as well as thin forceps have been developed to facilitate RPS. We have developed a device that can be used instead of forceps to hold organs in the abdominal cavity. The device is available in 2 sizes for accommodation by a 12-mm port or 5-mm port and is thus suitable for RPS.
Device specifications and method of use
The device, which we refer to as the FJ (free jaw) Clip, was manufactured for us by Charmant Inc. (Sabae city, Fukui) and is made of stainless steel. Because it can be sterilized, it is reusable and thus economical. It can be easily inserted and removed with conventional laparoscopic forceps. The clip, which is available in 2 sizes—30 mm and 35 mm—is short for effective organ lifting. It has a strong grasp but causes no or only negligible damage to organs.
Preliminary clinical results
The steps to actual clinical application involved development of several prototypes, experimental use in animal models, and approval for commercial distribution under the Pharmaceutical Affairs Law. We first used the 12-mm-port clip for laparoscopic resection of a gastric GIST. We used the clip effectively in 4 cases to hold the stomach wall, and there was almost no damage to the grasped tissue, so the clip was proven to be capable of playing the role of forceps. We used the 5-mm-port clip mainly to grip the abdominal side of the gallbladder during laparoscopic gallbladder extraction with a 1-cm cut at the umbilicus, 2 ports, and thin forceps. We performed 12 such surgeries under imaging guidance. We encountered no intra-operative problems, and the average operation time was 97 minutes. No postoperative complications ensued. We have now had experience in 53 cases, with an average operation time for 2 ports at the umbilicus plus an additional port of 127 minutes. Thus, the operation time has been shortened significantly.
Conclusions/future directions
Thus far, the FJ Clip has proven to be very effective for holding organs in the abdominal cavity during laparoscopic surgery. According to our experience, we believe the newly developed FJ Clip will replace conventional forceps for various tasks in laparoscopic surgery.
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