Ping Pan, MD, Seeyuen Lee, MD, MPH, Philip L Leggett, MD. Houston Northwest Medical Center
Objective: Percutaneous instruments less than 3mm in diameter introduced by tiny stab incisions through the skin are becoming more streamlined, more versatile, and easier to assemble. With this ease of placement, the idea that primarily performing a surgery via 5mm trocars as the most minimalist option is becoming increasingly out of date. The second generation Percuvance by Teleflex is the next advancement in minimally invasive technology.
Description of Technology: The second generation Percuvance limits the skin incision size to less than 3mm, and yet has an easy to attach tip that has the same utility as a 5mm instrument. Multiple types of tips are available with the second generation including a curved dissection tip similar to a Maryland grasper as well as variations on the blunt grasper tip.
Assembly is also simpler than that of its first generation predecessor. To attach and engage a tip, the mnemonic “A-C-L” can be used: Attach the tip, Close the handle, Lock in place by pulling back on the knob so the green is exposed. To remove a tip, the steps are simply reversed: Unlock by pushing forward on the knob so the green is no longer visible, Open the handle, and Remove the tip.
Placement of the device adds little time to the surgery once staff has been trained to quickly assemble the device, which can normally be achieved after 2-3 cases. At our institution, the amount of time required for placement and assembly of two second generation Percuvance instruments, which we use for both laparoscopic sleeve gastrectomies and fundoplications, is less than 5 minutes. Any initial prolongation of the procedure is compensated at the completion of the case by obviating the need to suture close what would have been two additional 5mm trocar sites; the percutaneous incisions can be simply sealed with the application of skin glue.
Conclusion: Patients are extremely pleased with their results from both a cosmetic and pain standpoint, as the incisions are barely visible by their follow up appointments less than 10 days later. Though there may be a concern the thin shaft limits the use of the second generation Percuvance to select patients for fear of bending the instrument, we have had significant success with the device in performing laparoscopic sleeve gastrectomies in bariatric patients up to a BMI of 52.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 84294
Program Number: ETP747
Presentation Session: Emerging Technology Poster
Presentation Type: Poster
