Objective As minimal access surgery continues to evolve for greater patient benefit, there is a need for enabling technology that performs simply, reliably and efficiently in response to surgeons’ real-world requirements. Furthermore, novel devices need to function intuitively and seem immediately familiar and so need be compatible with existing instrumentation and accommodate variety of use in differing healthcare settings. The ‘Sealed Incision Multiport’ (SIMPORT TM) is such a unifying access system for laparoendoscopic surgery that compliments procedural performance across the full spectrum of operative approach (whether single port or multiport laparoscopy or intraluminal transanal working) for intra-abdominal pathology.
Description The SIMPORTTM is a device for sealing small diameter (2-9cm) surgical incisions or natural orifices to enable their capture for laparoscopic or endoscopic operation. It is a sterile, flexible construct that hermetically seals standard wound protectors-retractors and can be mounted onto simple anoscopes to facilitate Transanal endoscopic microsurgery(TEM)-type procedures. Its upper component provides self-sealing conduits (4-5) for the introduction of regular laparoscopic trocar sleeves (disposable/reusable/reposable) to allow easy grouping of a standard straight and roticulating instrumentation within the confined access site. The device’s membrane thickness, elasticity, and durability are specifically configured to maximize instrument ergonomics and maneuverability within a narrow diameter area to ensure optimal working fluency without impedance. The SIMPORTTM is entirely compatible with the entire current portfolio of laparoscopic instrumentation regardless of brand and is interchangeable between/during operations to facilitate adaptation to unexpected circumstances.
Preliminary results Utility and effectiveness of the SIMPORTTM has been proven in an extensive series of bench and biomedical tests using different operators to gauge applicability and effectiveness in a variety of settings. Once in situ in either a box or porcine model, it has been shown entirely compatible with all standard straight rigid laparoscopic instrumentation (allowing enhanced tip triangulation) and, throughout rigorous testing involving multiple instrument exchanges and extreme positioning, it has proven secure, robust, durable and leak-tight. In porcine testing, 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 TEM by providing a stable platform for intrarectal resection. Throughout and after testing completion, the device retained its configuration and performance characteristics in their entirety.
Conclusions Rather than overly specific, prescriptive, niche technology, there is a clear need for devices that compliment departmental capability and performance. The SIMPORT TM is fit for purpose across the full spectrum of minimal access surgery as it possesses many of the ideal qualities of a single device that will encompass and unify access options for the contemporary laparoendoscopic surgeon. Clinical trialing is planned in the immediate future and early experience conclusions will be available for presentation by April 2012.
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