The Routine Use of Newly Developed Miniscope for the Pediatric Microlaparoscopy – Solutions for the Technical and Mechanical Challenges

Salmai Turial, MD, Felix Schier, MD PhD. University Medical Center Mainz, Department of Pediatric Surgery

Objective

Since February 2009, serially manufactured micro-laparoscope was used routinely for minimally invasive pediatric surgery. Breakage of the scope shaft and mechanical instability of the scope were the main disadvantages compared to using conventional 5 mm scopes. The aim of the present work is to report the possibility of eliminating and reducing the disadvantages of the mini-scope and to present further technical solutions currently subject to investigation.

Method
During a period of two years, 12 mini-scopes were used for the routine micro-laparoscopic procedures in children and adults. Technical instability, optical feasibility, wastage and comfort of handling during operative procedures are the subject of continuing prospective investigation.

Preliminary Results
Out of 12 scopes, five scopes were broken at the scope shaft and scope-head junction point. Two other scopes had a hole in the welding at the same junction point. The average time of use for mini-scopes was limited to four months. The reason for the breakage is suspected to be a failure in the welding during the manufacturing process. For three of the remaining scopes purchased, the scope shaft junction point was strengthened by additional welding (8mm length up to 2mm thickness) by the surgeon himself. After contacting the manufacturer, the new version of this scope will now be produced by relocating the welding junction point within the scope head. Since the scope (with an outside diameter of 2.4mm) fits very tightly into the mini-port (inside diameter 2.49mm), a thin film of water had dripped down in front of the lenses, making the visualization and illumination weak. We developed a so-called “trocar cleaner” to dry the inside of the trocar. However, an optimal tissue and holder instrument to dry the trocar still must be found. For this purpose we used a small part of a compress in a needle holder. The compress is not ideal, as traces of it are left behind in the trocar. In addition to these findings, a new anti-bending device prototype has been developed, which is a subject of a separate report.

Future directions
The results of the new modification of the scope shaft junction point within the scope-head still must be proven in routine practice. An ideal cleaning tissue and the process of its sterilization has to be found.