YongHo Jeon, Prof1, Bummo Ahn, PhD2, Kil Yeon Lee, MD3, Sun Jin Park, MD3, Moon Gu Lee, Prof1, Sungwoo Cho, MD, PhD4. 1Ajou Univ., 2Kitech, 3KHUSM, 4Soonchunhyang University Seoul Hospital
Objective of the technology or device
There have been difficult to ensure good visibility around dissection position because of the limitation of traction and/or retraction when the surgeon performs non-invasive surgery like laparoscopic or NOTES (natural orifice transluminal endoscopic surgery). In this study, we developed novel traction and/or retraction device and method with magnet, wire and clip and applied it to a swine model surgery to investigate the technical feasibility of laparoscopic or NOTES cholecystectomy.
Description of the technology and method of its use or application
In order to tract and/or retract small organs easily, the device and method of traction/retraction is proposed and implemented. The device has an external hand-held magnetic manipulator and an internal ferrous "attractee" with a wire and bullet. The design of internal ferrous attractee is with the bullet and wire like fishline because it is flexible. Also the bullet is shaped like small dumbbell because endoscopic or laparoscopic gripper can hold the bullet easily without the slip.
The attractee is delivered through a working channel. Because the diameter is compatible, there is no difficulty. This dimension is also applied to the updated version. The assistant is holding the external magnetic manipulator. The attractee is approached and its wire is engaged to GB using laparoscopic clips. The “attractee + GB” is then pulled to peritoneal wall. After engaging the wire to GB with using clip, the bullet pulled and attached to inner peritoneal wall. The attaching force is from the external magnetic manipulator. Once the manipulator is reached the location, the bullet is attached by the magnetic force which came from the manipulator.
The novel hook-attached magnetic traction/retraction is feasible to applying to minimally invasive surgery. This can eliminates aid of assistant so that the medical expense of people can be reduced. The mean procedure time was 170 minutes (range, 140 to 190 minutes). There was no intraoperative complication or hemodynamic instability.
Conclusions / future directions.
The procedure of hanging the bullet to peritoneal wall is still to be improved. Also the clipping wire to organ is not easy to surgeon, therefore, a brief training is needed. For full elimination of assistant, a fixation device of the external magnetic manipulator is to be developed but the cost of the device should be considered. The bullet can be stuck to surgical tools because they usually contain some magnetic materials. Therefore, electromagnet is recommended instead of permanent magnet. In this case, the cost of the device also should be considered.