Sealed Incision Multiport (SIMPORT): A Unifying Access Device for Transabdominal and Transanal Laparoendoscopy

Deirdre F Waterhouse, Dr, Ronan A Cahill, Dr. European Institute of Surgical Research and Innovation (EISRI)

INTRODUCTION: The new avenue of laparoscopy referred to as Single Incision Laparoscopy is often presented as an alternative to more conventional laparoendoscopic approaches whereas in fact it is really a complimentary procedure. The benefits of this technique’s principles can be of broader utility both to patients and surgical specialties if they can be harnessed to allow next-stage evolution through synergy with more mainstream practice. In particular, rather than device specificity what is needed is convergence of capability that the same surgeon can apply in differing scenarios depending on the individual patient/disease characteristics. We detail here the global, unifying applicability of a novel access device construct that allows the provision of simple and complex single port laparoscopy as well as contributes to multiport laparoscopic operations and transanal resections in a manner that is reliable, reproducible and extremely ergonomical.

METHODS: The Sealed Incision Multiport (SIMPORTTM) comprises a single piece of flexible, elastic material specifically configured for application onto either surgical incision sites (2-9cm diameter) or natural orifices. Its design allows accommodation of standard laparoscopic trocars in a non-prescriptive fashion (i.e. full compatibility with all commercially available trocar sleeves 5-12mm in internal diameter regardless of brand) with either four or five dedicated conduits mounted on its upper dome along with a separate outlet that mates with gas sufflation tubing. Its lower cylindrical chamber is designed to stretch hermetically over standard wound protector-retractors or circular anal dilator (CAD) devices in common use and thereby permit and maintain a pneumoperitoneum or pneumorectum respectively. It has been carefully designed to be fit for purpose either as a single port, an adjunct access during multiport procedures (especially those that involve incisions for specimen extraction or stoma maturation) or for transanal intraluminal working. To test its utility and effectiveness, a series of bench and biomedical tests were performed using different operators to gauge applicability in a variety of settings.

RESULTS: The SIMPORT proved an excellent fit both onto the commonest wound protectors and CAD devices and with a variety of conventional laparoscopic trocars (whether reuseable, reposable or disposable). Once in situ either a box or porcine model, it was entirely compatible with all standard straight rigid laparoscopic instrumentation (allowing enhanced tip triangulation) and throughout rigorous testing involving multiple instrument exchanges and extreme positioning was secure, durable and leak-tight. In porcine testing (n=2), at a variety of site placements, it facilitated full laparoscopy, cholecystectomy and ileal resection as well as anterior resection and re-anastomosis (for the lattermost procedures, additional wide diameter stapling instrumentation were readily accommodated alongside the optic and two other retracting instruments). Additionally, it enabled transanal operating equivalent to Transanal Endoscopic Microsurgery (TEM) by providing a stable platform for intrarectal resection. On examination during and after completion of the operative series, the device retained its configuration and performance characteristics in their entirety.

CONCLUSION: Considerable preclinical testing has shown the SIMPORTTM possesses many of the ideal qualities of a single device that will encompass and unify many different access options for the contemporary laparoendoscopic surgeon.

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