Minilaparoscopy with Interchangeable, Full 5-mm End Effectors: First Human Use of a New Minimally Invasive Operating Platform.

Abstract

The most common paradigm in minimally invasive surgery is entry of a single trocar through separate incisions in the abdomen. However, in an effort to decrease postoperative pain and minimize scarring, alternative techniques have been described. Needlescopic surgery uses instruments that are 3 mm or less in diameter. Prior uses of needlescopic instruments have been hindered somewhat by diminished shaft strength and small end-effector size. The Percuvance™ (Teleflex, Wayne, PA) system uses a 2.9-mm shaft with interchangeable 5-mm end effectors in order to minimize abdominal wall trauma while maintaining the functionality of traditional laparoscopic instruments. All patients evaluated for laparoscopic surgery by two surgeons with a foregut and general surgery practice at the Cleveland Clinic (Cleveland, OH) were included in the study. Fifteen consecutive patients were enrolled in the study. Patient demographics and operative results were reviewed. In March 2015, 15 patients underwent surgery using the Percuvance surgical system at the Cleveland Clinic. There was one conversion to open surgery due to extensive intraabdominal adhesions and unclear anatomy. There was one re-exploration for presumed anastomotic leak, which was negative. Operative time and length of hospital stay were similar to those of standard laparoscopic procedures. There were no deaths in this series. Subjective surgeon experience was overall positive, and functionality of the Percuvance system seemed equal to that of standard 5-mm laparoscopic instrumentation. This initial experience with the Percuvance system demonstrated effective exchange of 5-mm port sites for needlescopic instruments with similar handling to traditional laparoscopic instruments. This interchangeable system may allow performance similar to standard laparoscopic port instrument orientation and principles in the setting of decreased-caliber access.