Use of a Novel, Self-contained Tissue Retraction Device to Reduce Trocar Site Number in Laparoscopic and NOTES-based Surgical Procedures

In an effort to make laparoscopic surgical procedures even less invasive, single port access and natural orifice transgastric endoscopic surgical (NOTES) approaches have been developed over the past several years. However, the need to maintain basic surgical working principles, such as proper tissue retraction to create tension and counter-tension, is still of critical importance if emerging techniques are to be successfully implemented. New self-retaining retraction devices that do not require dedicated trocar placement represent a technology that could help to bridge the gap between traditional laparoscopy and less invasive techniques. One such device (EndoGrab™, Virtual Ports Ltd) utilizes a fully insertable, self-contained, double hook configuration to generate tissue retraction by providing a means of atraumatic tissue attachment between either 2 adjacent visceral structures or between the viscera and the abdominal wall. The device can be repositioned at will throughout the operative case, and allows for both the elimination of a dedicated transabdominal port and the need for active assistant retraction. Additionally, a flexible applicator will allow the device to be introduced through an overtube via a natural orifice. This video shows the use of the EndoGrab™ device in both basic and advanced laparoscopic procedures, as well as in a technically challenging NOTES operative case.

When used in a laparoscopic cholecystectomy, the EndoGrab™ is introduced through a 5 mm port. One of four usual operating ports is eliminated such that only two working ports and a camera port are needed. The device allows for initial suspension of the fundus, and subsequently, the gall bladder body, from the abdominal wall above. Consequently, critical operating views of the structures within Calot’s triangle are well-visualized with the cephalad retraction provided by the device.

Similarly, in more complex laparoscopic cases such as repair of paraesophageal hernia, the EndoGrab™ is again be used in lieu of placement of a port for assistant retraction. The device is placed on the stomach in various locations to allow for adequate visualization of critical structures during dissection, crural closure and fundoplication creation. Use of the EndoGrab™ allows the procedure to be completed with four rather than five incisions.

Not only does the EndoGrab™ allow for the reduction in number of incisions, but in certain cases, it can help eliminate the need for transabdominal ports. With the continued development of NOTES equipment and technology, tools like the EndoGrab™ can play critical roles in procedures accomplished with access exclusively through natural orifices. Given that currently available NOTES platforms make lateral retraction and dissection of the gall bladder difficult during cholecystectomy, the EndoGrab™ serves a novel solution in this video.

In conclusion, the EndoGrab™ represents a valuable technological advance that allows traditional laparoscopy to be done with fewer trocar sites, and may facilitate NOTES procedures in becoming truly externally incisionless.

Session: Podium Video Presentation

Program Number: V041

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