Objective
Improve the efficiency and accuracy of maintaining visual exposure of the operative field during laparoscopic surgery and mimic the multiple simultaneous views of standard open surgical approaches. This accomplishes the added benefit to allow for fewer ports and assistants. This system will provide multiple, simultaneous views that are in full control of the surgeon and synchronized to the surgeons working instruments without expensive technological requirements.
Description of the technology and method of its use or application
This is a laparoscopic access port that contains a miniaturized video camera and light source at the tip. The portion of the tip that houses the optics is raised, similar to how the hood of a car is raised. Once raised, it provides an “off-axis”, illuminated view of the operative field and instrument tip. These vision-enhanced working ports are used to provide multiple, simultaneous views of the operative field without the need to move a camera/scope to a different port. Additionally, all instruments passed through this port will remain in its field of view at all times. The images can be displayed simultaneously on one monitor, or separate monitors. Alternatively, the images could be toggled back and forth on a single monitor, similar to what is currently done when the scope is moved to a different port.
Preliminary results
During a laparoscopic cholecystectomy and suturing exercise in a non-survival swine model, we utilized two video cannulas that were used as the working ports. Both images were displayed on separate monitors immediately adjacent to one other. This eliminated the need for a dedicated scope port, and need to hold the scope. It also eliminated the need to attain additional views by moving the scope to another port, because the multiple views were simultaneously displayed. While initially concerned that this would be confusing, it turned out to be extraordinarily intuitive, mimicking open technique.
Conclusions / future directions.
Providing multiple, simultaneous images mimics the view from open operative techniques, and may be safer than standard laparoscopes by keeping the instruments in the field of view constantly. Additionally, operative efficiency may be improved by allowing the surgeon to control the field of the view solely by manipulating the instruments in the standard fashion. This enhances the assistant’s performance and/or enables additional tasks to be performed by the assistant. Improving the view may also enhance the learning curve of laparoscopic techniques by reducing the physical and mental effort to maintain a view of the operative field. Improved efficiency may benefit both graduate medical education, and enhance the ability for practicing surgeons to provide learn new laparoscopic procedures. Future directions will be concentrated on refining the system to improve overall efficiency and reduce overall cost. This technology is also another step at improving and enabling both single port surgery and NOTES.
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