Laser Guided Laparoscopic Ventral Herniorrhaphy

Danny A Sherwinter, MD, Matthew Dixon, MD. Maimonides Medical Center Department of Minimally Invasive Surgery

Introduction: Excellence in laparoscopic ventral herniorrhaphy (LVH) requires precise mesh placement and meticulous transfascial suture placement. Yet despite these demanding requirements, LVH is routinely performed using nothing more than visual estimations, leading to inadequate mesh coverage, inaccurate suture placement and may play an important role in the high recurrence rate seen with this technique.
We describe our initial experience with a novel transabdominal laser projector which provides a virtual roadmap for mesh and suture placement in LVH.
Description of Technology: A laser projector designed to create a 2 dimensional “roadmap” indicating mesh and suture position is directed down a cannula and into the abdomen. By then bouncing the laser off a spherical convex mirror built onto the end of the cannula, the image is reflected back onto the peritoneal surface. The laser image is viewed intra-abdominally through the laparoscope and indicates: dead center, correct mesh overlap and transfascial suture position. The intra-peritoneal laser map corresponds to printed markers on the mesh and allows for a high degree of mesh and suture placement accuracy.
Conclusions: This study introduces a laser guidance system designed to improve the accuracy of mesh positioning and suture placement in LVH. This device may be especially useful for novices and for training surgeons in LVH.

Session: Emerging Technology
Program Number: ET003

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