Mini-laparoscopy with Interchangeable, Full 5mm End Effectors: First Human Use of a New Minimally Invasive Operating Platform From Two Academic Medical Centers

Mena Boules, MD1, Julietta Chang, MD1, James Villamere, MD1, Gautam Sharma, MD1, John Rodriguez, MD1, Luigi Boni, MD2, Matthew Kroh, MD1. 1Cleveland Clinic, 2University of Insubria-Italy

Introduction: The technology of minimally invasive surgery continues to progress in efforts to decrease postoperative pain and minimize scarring. Needlescopic devices (shaft diameter <3mm) represent one such innovation. Widespread use of needlescopic instruments has been hindered by diminished shaft strength and small or ineffective end-effectors. The Percuvance™ system uses a 2.9mm shaft with interchangeable, full 5mm end-effectors in order to minimize abdominal wall trauma while maintaining the functionality of traditional laparoscopic instruments. We describe the first human experience of these new instruments at two academic medical centers.

Methods:Consecutive, unselected patients evaluated for laparoscopic surgery by 3 surgeons at Cleveland Clinic, and the University of Insubria were included in the study. Patient demographics and operative results were reviewed.  Technical maneuvers using the new instruments are described.

Results: 51 consecutive patients underwent surgical procedures (n=23 laparoscopic cholecystectomy, n=8 colectomies, n=6 Nissen fundoplications, n=5 laparoscopic jejunostomy, n=2 laparoscopic sleeve gastrectomy (LSG), n=1 Roux-en-Y gastric bypass (RYGB), n=1 gastric electric stimulator placement, n=1 gastric electric stimulator explant, n=1 ventro-peritoneal (VP) shunt revision, n=1 laparoscopic paraesophageal hernia repair, n=1 laparoscopic duodenojejunostomy, n=1 laparoscopic ventral hernia repair (VHR) with mesh) with the use of the Percuvance™ surgical system. All operations included Percuvance instruments, ranging from 1-3 replacement of standard trocars.  Percutaneous shafts were exchanged with different end-effectors throughout the case as needed.  One patient was converted to open surgery due to extensive intra-abdominal adhesions and unclear anatomy. One patient underwent re-exploration for presumed anastomotic leak which was found to be negative. Operative time, and length of hospital stay was similar when compared to standard laparoscopic procedures. There were 3 device malfunctions, which were rectified by instrument exchange. Subjective surgeon experience was overall positive and functionality of the Percuvance™ system seemed equal to standard 5mm laparoscopic instrumentation. Follow-up as outpatient demonstrated excellent patient satisfaction with scars from Percuvance insertion sites.

Conclusion: This initial experience with the Percuvance™ system demonstrated effective exchange of 5mm port sites for needlescopic instruments with equivalent performance through smaller incisions with similar handling to traditional laparoscopic instruments, in addition to smaller incision sites. This interchangeable system may allow performance similar to standard laparoscopic port instrument orientation and principles in the setting of decreased-caliber access.

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