Emanuele L. G. Asti, MD, FACS, Andrea C Sironi, MD, Luigi Bonavina, MD, FACS. IRCCS Policlinico San Donato
Among the major problems that occur performing minimally invasive surgery (laparoscopy-thoracoscopy) we have: the correct and effective illumination of the surgical field, the vessels identification through trans-illumination of the surgical structures and the guided dissection in complex surgical fields.
The main objective is to improve efficiency and safety during some surgical procedures.
Description of the technology and method of its use or application.
We designed a device of simple manufacturing and use. The LAD consists of two cylindrical parts (A and B) with tapered ends connected by a soft power cable and an external remote control.
Part A (illuminating) is 0,9 cm thick and 7 cm length. It’s made of a semi-rigid polymer with a transparent central part with two radio-controlled LEDs inside. The surface is soft and corrugated in order to improve grasping with standard laparoscopic instruments. At one end, there is a shackle in order to pass a wire to fix or extract the cylinders. On the opposite side there is a 40 cm length soft power cord that connects Part A with B.
Part B (gives power to Part A and a has a WiFi connection with the external remote control) is 0,9 thick and 9 cm length. It’s made of a rigid polymer.
LAD is waterproof, atraumatic and has a complete thermal and electrical insulation. This instrument is disposable.
LAD can be preferentially used in laparoscopy and thoracoscopy, but we can find also application in open surgery. The device is introduced in the surgical cavity (through a 10 mm trocar): Part A is moved in the main surgical field where needed and Part B can be safely placed in the opposite site.
LAD application fields:
Retrogastric illumination (ie: identification of gastroepiploic arcade, during Ivor-Lewis esophagectomy)
Perisplenic (ie: short gastric vessels identification)
Small / large bowel meso transillumination (ie: identification of the vascular arcades making easier and safier the resection and the anastomosis during laparoscopy)
Winslow foramen (ie: Transillumination of the lesser omentum to dissect hepatic pedicle)
Lower Mediastinum (ie: during dissection/anastomosis in laparoscopy – open surgery)
Rectal Pelvic dissection
Higher mediastinum (ie: esophageal dissection/anastomosis)
LAD is a patented device.
The device was extensively tested in dry lab and animal lab (according to Italian Committee for Animal Care – OPBA). No adverse events reported. All the previously reported application fields were tested by four well trained surgeons with positive feedback.
Conclusions / future directions
Preliminary data indicate that the use of the LAD can make it more safe and reproducible surgical passages.
More data will be needed to understand the real human applications, costs, and possible adverse effects.