Percutaneous Surgical System Research Articles

A novel mini-retractor for retroperitoneal laparoscopic partial nephrectomy.

Retroperitoneal partial nephrectomy (RLPN) is the premier treatment for localized renal tumors despite narrow operation space. Many efforts have been taken to facilitate the operation of RLPN, but the optimal resolution remains debatable. To explore the feasibility of using Mini-lap to improve workspace and surgical vision in RLPN. A multicenter retrospective review of 51 patients who underwent RLPN with Mini-lap from January 2018 to December 2020 was conducted. Standard RLPN under three poles was performed in all cases. We highlighted the usage of Mini-lap (Teleflex Minilap percutaneous Surgical System) as a novel retractor in RLPN. Demographics, preoperative, intraoperative, and postoperative outcomes were assessed. All 51 cases completed RLPN with three ports successfully and no conversion to open surgery. The mean diameter of tumors was (3.53 ± 1.05) cm, in which 62.7% (32/51) were located anteriorly. The operation time and warm ischemic time (WIT) were (86.7 ± 15.9) min and (25.6 ± 5) min respectively. Minor complications (Clavien grade 1-2) occurred in 6 cases. The limitations were small sample size, retrospective design, and absence of control. Mini-lap could be used as a mini-retractor in RLPN, sparing extra assistant ports, expanding workspace, and optimizing vision. With highlights of larger workspace and less instrument interference, mini-lap could be applied in retroperitoneal laparoscopic partial nephrectomy.

Feasibility and perioperative outcomes of percutaneous-assisted laparoscopic hysterectomy: A multicentric Italian experience

ObjectiveThis multicentric prospective phase II study aimed to investigate the feasibility, safety, and efficacy of percutaneous-assisted laparoscopic hysterectomy in terms of perioperative outcomes, feasibility, VAS score, and cosmetic outcomes. Study DesignBetween May 2015 and October 2017, 382 patients were considered eligible for minimally invasive percutaneous-assisted laparoscopic hysterectomy using Percuvance™, Percutaneous Surgical System - PSS, TELEFLEX ltd. Among them, 80 patients (20.9 %) met the inclusion criteria and were enrolled in the study.The coordinator center was the Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. Enrolled patients underwent total percutaneous-assisted laparoscopic hysterectomy ± bilateral salpingo-oophorectomy ± nodal assessment. ResultsThe median age was 52 (range, 32–80) years, and the median body mass index was 25 kg/m2 (range, 16–37). Thirty-five patients (43.8 %) had previous surgery. A median operative time of 82.5 (range, 40–190) minutes and a median estimated blood loss of 50 (50–500) mL were registered. We observed 1 (1.3 %) intraoperative complication. The median time to discharge was 1 (range, 1–5) day. Patients were extremely satisfied with the scar evaluation and postoperative pain control. Five (6.25 %) complications were recorded within 30 days after surgery. ConclusionPercutaneous-assisted technique for extrafascial hysterectomy achieved excellent results in terms of feasibility, safety, and efficacy, even in complex cases and advanced surgical procedures. Therefore, the technique appears to balance the limitations and advantages of minimal surgical invasiveness and standard approach efficacy.

Complete percutaneous laparoscopic cholecystectomy by employing the Percuvance Percutaneous Surgical System.

Laparoscopic cholecystectomy (LC) has been the gold standard in the treatment of gallbladder disease. More than 50 different techniques of LC have been developed and performed, which seem to offer much in postoperative outcome and cosmesis. However, each has its limitations in practice mainly due to the long learning curve, or lack of appropriate instruments. The current paper studies the application of percutaneous LC employing the Percuvance Percutaneous Surgical System and reports the first documented complete percutaneous LC in the literature. Complete percutaneous LC was performed in fifteen patients diagnosed with cholelithiasis, the Percuvance Percutaneous Surgical System from Teleflex was used. All operations were performed with the use of a single 10 mm Hassan Trocar port and a 30o degree camera. Complete percutaneous LC with the use of percutaneous Instruments was applied in all cases. No conversions to open cholecystectomy were reported. Mean operating time was well within the standard for LC. Postoperatively, no complications were observed, while all patients were discharged the next day. Excellent cosmesis and satisfied patients were the long-term results. Percutaneous LC with the use of a 10 mm Hassan trocar, bears the potential of being a favorable alternative in cholecystectomy.

Technological innovation and personalized surgical treatment for early-stage endometrial cancer patients: A prospective multicenter Italian experience to evaluate the novel percutaneous approach

ObjectiveTo investigate the safety, feasibility and oncological adequacy of the Percutaneous Surgical System - PSS in a consecutive series of low-risk endometrial cancer staging. Study DesignFrom May 2015 to April 2017, we prospectively performed 30 consecutive percutaneous staging for low/intermediate risk endometrial cancer (FIGO stage IA G1-G2, IB G1-G2, IA G3). All patients were divided in two different groups on the basis of surgical procedure received: Group A included patients submitted to radical Class A hysterectomy and bilateral salpingo-oophorectomy; Group B concerned patients that received a lymph nodal assessment also. ResultsThe time needed to install percutaneous instruments and suprapubic trocar was 4 min. (range 2–10). The recorded median operative time (OT) was 80 min. (range 65–120) for Gr.A and 143 min. (range 107–190) for Gr.B, in which the median time of lymph nodal assessment was 55 min. (range 20–76). The median time for hysterectomy was 60 min. (range 40–110) in all cases. Lymph nodal assessment was performed in 14 (46.6%) cases: 7 sentinel node mapping, 7 pelvic lymphadenectomy. No intraoperative complications or LPS/LPT conversions were recorded. Median discharge time was 2 days (range 1–4), 5 patients were discharged in 3rd post-op day, and only 1 patient was discharged in 4th day for fever. All patients conveyed high satisfaction with the cosmetic results. A progressive overall reduction of pain perception was observed at 24 h after surgery. Median follow-up was of 14 months (range 12–36), no recurrences have been detected. ConclusionsPSS seems to be a feasible approach for endometrial cancer staging. Larger experiences and prospective comparative studies are important to assess our assumptions and further investigate the real benefits of percutaneous surgical system.

Percutaneous Approach for Early-Stage Endometrial Cancer Staging: A Prospective Multicenter Italian Experience

Objective: To evaluate the safety, feasibility, and oncological adequacy of the Percutaneous Surgical System - PSS in a consecutive series of low-risk endometrial cancer staging.

Mini-laparoscopic cholecystectomy with the MiniLap® percutaneous surgical system: a series of 32 patients.

BackgroundIn recent years, mini-laparoscopic procedures are gaining the preference of most surgeons due to their potentially better surgical outcomes. The Mini Lap Percutaneous Surgical System with MiniGrip® Handle is currently the less invasive instrument and can be applied to a wide range of operations. The current paper presents its application on percutaneous laparoscopic cholecystectomy.Materials and methodsFrom January 2017 to June 2017, 32 patients underwent percutaneous laparoscopic cholecystectomy with the MiniLap® system. All operations were performed by the same surgical team.ResultsNo conversions and no overall complications were reported. Drainage were not necessary. Mean surgical time was 35 minutes, while patients were released in <24 hours after the operation.ConclusionThe MiniLap system with the use of the mini grip handle seems to sustain the benefits of performing laparoscopically. However, further trials should be conducted so as to establish its safety on cholecystectomies.

Laparoscopic supracervical hysterectomy and sacral colpopexy for pelvic organ prolapse with percutaneous surgical system: Results from a pilot study

ObjectiveThe aim of the study was to report our preliminary experience of supracervical 2 hysterectomy followed by sacral colpopexy performed with the Percuvance ™ PSS in terms of feasibility, effectiveness and safety. Study designBetween Jan 2017 and Feb 2017 10 patients affected by POP were enrolled in the present study. All patients undergoing supracervical hysterectomy followed by sacral colpo-cervicopexy with the Percuvance ™ PSS. ResultsThe reported series consisted of 10 patients undergoing supracervical hysterectomy followed by sacral colpopexy with a median age of 63 years (range 55–71 years) and a median BMI (body mass index) of 24 (range 21–26). A median operative time of 123 min (range 103–134 min) and a median estimated blood loss (EBL) of 40 ml (range 20–60 ml) were registered. No conversions to standard laparoscopy or laparotomy were required and no intraoperative complications occurred. At the discharge all patients were completely satisfied with the cosmetic result and postoperative pain control. During 3 months urogynecological follow-up no patient showed surgical anatomic failure (>2 POP-Q stage)and the degree of overall satisfaction of the cosmetic results was confirmed by the surgeon and the patient equally. ConclusionsThe PSS supracervical hysterectomy plus sacral colpopexy is a feasible and effective approach with good results in terms of operative time, cosmesis, postoperative pain and length of hospitalization.

495 - Nerve-Sparing Laparoscopic Colposacropexy Using a Percutaneous Surgical System: A Case Report

Objective: to evaluate the feasibility, efficacy, and safeness of nerve-sparing laparoscopic colposacropexy performed with a minimally invasive approach by using 2.9-mm Percuvance percutaneous surgical system (PSS).

Laparoscopic, minilaparoscopic, single-port and percutaneous hysterectomy: Comparison of perioperative outcomes of minimally invasive approaches in gynecologic surgery

ObjectivesDuring the last decade endoscopic surgical procedures have been constantly evolving. The latest innovation in ultra-minimally invasive surgery (MIS) is the percutaneous technology (Percuvance™ Percutaneous Surgical System (PSS), Teleflex Inc., USA). We compared surgical outcome of hysterectomy, in a retrospective cohort study using the most recent MIS techniques as single-site (LESS) surgery, 3mm laparoscopy (MiniLPS) and percutaneous system (PSS) with standard laparoscopy (LPS). Study designThis is a matched retrospective cohort study. Endometrial Hyperplasia/Early stage endometrial cancer or benign pathology were the indication for surgery. Data of laparoscopic hysterectomies performed between May 2013 and April 2016 using PSS, LPS, MiniLPS, and LESS were collected and compared. ResultsThe characteristics of each group were similar. The median Operative time (OT) was significantly longer in LESS compared to all other groups (120min [range 55–165] in LESS, 91min [range 60–180] in MiniLPS, 70min [range 55–230] in LPS and 65 [range 40–180] in PSS; p=0.0001). No significant differences among the 4 groups were observed in terms of estimated blood loss, conversion to laparoscopy or laparotomy, and intra e post-operative complications. Statistically significant differences were recorded in median VAS 24h (2 [range 0–3] in PSS, 2 [range 0–3] in MiniLPS, 3 [range 2–5] in LESS and 2 [range 1–5] in LPS; p=0.0001). The average time of discharge was (1day [range 1–3] in PSS, 1day [range 1–2] in MiniLPS, 1days [range 1–2] in LESS and 1day [range 1–3] in LPS; p=0.99). ConclusionsData show that the effort to minimize the impact of surgical invasiveness can be feasible and could improve the advantages, not only in terms of aesthetic outcomes, even if the differences among the endoscopic approaches have not a relevant clinical impact. The technology innovations like PSS maintain the same triangulation between instruments as standard LPS with an evident decrease of the invasiveness thanks to reduced instruments size, even if the lack of suitability of bipolar energy, that require a multifunction instrument, remain a limit of these instruments.

Nerve-Sparing Laparoscopic Colposacropexy Using a Percutaneous Surgical System: A Case Report

Study ObjectiveThe primary aim of this study was to evaluate the feasibility, efficacy, and safeness of nerve-sparing laparoscopic colposacropexy performed with a minimally invasive approach by using 2.9-mm Percuvance percutaneous surgical system (PSS; The Percuvance System; Teleflex Inc., Wayne, PA). The secondary aim was to investigate the technical performance of these instruments as needle holder in the placement of the mesh. The final aim was to establish the rate of prolapse recurrence. DesignStep-by-step video demonstration of the surgical technique. SettingThe Internal Department Committee approved this study. PatientThe patient was adequately informed about the possible risks and benefits of this experimental technique, and a written consent agreeing to undergo the described procedure was signed. InterventionNerve-sparing laparoscopic colposacropexy with positioning of two polypropylene titanized meshes and concomitant subtotal hysterectomy and salpingo-oophorectomy entirely performed with a 2.9-mm PSS. Measurements and Main ResultsPelvic organ prolapse is a condition affecting up to 50% of multiparous women. It may be considered a significant public health problem with an important impact on general health-related quality of life. A conservative and/or medical treatment may be considered only for women with a mild degree of prolapse, women with a reproductive desire, or women unable to undergo surgery. In the remaining cases, surgery seems to be the most effective treatment. The surgical approach may be abdominal (colposacropexy by laparotomy, laparoscopy, or robot-assisted) or vaginal (autologous or prosthesic reinforcement). The aims of the surgical procedures include not only the anatomic correction of the prolapse but also the improvement of patient quality of life and prolapse symptom relief, guaranteeing normal bladder, bowel, and sexual functions and avoiding iatrogenic dysfunctional symptoms. At present, the laparoscopic technique of sacral colpopexy offers a number of important advantages, including an excellent visualization of the pelvis, reduction in adhesions formation, and decreased postoperative pain and recovery, with reported success rates of 90% to 96% with a mesh erosion rate of 1% to 8%. ConclusionThis case report is the first to report a nerve-sparing laparoscopic colposacropexy performed with a 2.9-mm PSS. The major advance of this technique is the possibility of performing a major gynecologic surgery with a scarless approach, which results in fewer traumas for the patient in the postoperative time. The use of these instruments does not increase the operation time or the rate early or late complications, most of all prolapse recurrence. Considering that this is the first case report in literature, more clinical data are needed to confirm these findings.

A percutaneous technique of liver retraction in laparoscopic bariatric & upper abdominal surgery

BackgroundLaparoscopic bariatric surgery requires retraction of the left lobe of the liver to provide adequate exposure of the hiatus and the stomach. Currently used approaches utilize retractors that require additional incisions and prolong operative time. ObjectivesA retrospective evaluation of the efficacy and safety of a percutaneous liver retractor in a large series of patients undergoing laparoscopic bariatric surgery. SettingPrivate practice, United States. MethodsA retrospective chart review was performed on 2601 patients undergoing bariatric surgery from January 2011 to September 2015. A percutaneously introduced grasper (Teleflex MiniLap Percutaneous Surgical System, Morrisville, NC) was used to retract the left lobe of the liver in all cases. The retractor could be repositioned as necessary by releasing and regrasping the diaphragm at different locations. ResultsThis technique was used in 2601 patients from January 2011 until September 2015. The average body mass index was 43.1 (range: 20.6–80.3). In all patients, this new method was found to be satisfactory to complete the bariatric procedure. The majority of procedures included laparoscopic Roux-en-Y gastric bypass, sleeve gastrectomy, and gastric band placement. No intraoperative liver injuries occurred with use of the Teleflex retractor. ConclusionPercutaneous retraction of the liver using the Teleflex MiniLap Percutaneous Surgical System was found to be safe and effective in this large series of morbidly obese patients. The rate of complications involving this technique is extremely low. This novel method provides safe and effective retraction with less trauma and better cosmesis than conventional technique.

Total laparoscopic hysterectomy using a percutaneous surgical system: a pilot study towards scarless surgery

ObjectiveThe evolution of minimally invasive surgery has moved beyond reduction of surgical trauma while maintaining adequate efficacy and safety standards. Percuvance™ Percutaneous Surgical System (PSS) instruments represents the last novelty in this panorama. Consisting of less than 3mm laparoscopic shaft introduced percutaneously with an interchangeable 5mm tool installed in place of the needle tip, they combine micro-invasiveness and operative performance. Study designWe prospectively collected and retrospectively analyzed data of 10 cases of laparoscopic total hysterectomy with Percuvance™ PSS for benign or early malignant gynecological diseases in order to assess the capability and safety of this new device. Data were recorded in a prospectively designed clinical database including patient demographics characteristics, operative data, intra- and postoperative complications, conversion rate, length of hospital stay and cosmetic outcome. ResultsThe reported series consisted of 10 patients undergoing total laparoscopic hysterectomy with a median age of 51.5 years (range 44–72 years) and a median BMI (body mass index) of 25.3 (range 19.7–30.4). All patients had bilateral salpingo-oophorectomy or bilateral salpingectomy and two of them underwent pelvic lymphadenectomy. A median operative time of 67min (range 45–180min) and a median estimated blood loss (EBL) of 50ml (range 10–100ml) were registered. Median PSS introduction time was 5min (range 3–10min). No conversions to standard laparoscopy or laparotomy were required and no intraoperative complications occurred. Discharge was on day 1 in 4 cases, on day 2 in the other 6 cases. All patients conveyed complete satisfaction with the cosmetic result and postoperative pain control. No complications were registered within 30 days after surgery. ConclusionsPSS total laparoscopic hysterectomy is safe and feasible with good results in terms of operative time, cosmesis, postoperative pain, recovery and short hospitalization. Further studies are needed to compare PSS total hysterectomy to conventional multi-access laparoscopic and other mini-invasive approaches.

Pediatric laparoscopic cholecystectomy with 2.3 mm Percutaneous Surgical System (MiniLap®): A new frontier for pediatric mini laparoscopy?

Abstract Mini-laparoscopy represents an evolving and attractive field both in general and in pediatric surgery, with a pressing and increasing technical demand. Although the advantages of the mini-laparoscopic approach (reduced morbidity, less incisional pain and discomfort, better cosmetic results) are well recognized, its technical difficulties due to the lack of suitable and comfortable instruments brought to a limited use. Moreover, in the pediatric population, the need of ergonomic mini-invasive but efficient devices is the key of a widespread use of mini-laparoscopic surgery performed with an effective and safe technique. We aim to highlight the first case of pediatric laparoscopic cholecystectomy performed with 2.3 mm percutaneous instruments (MiniLap ® Percutaneous Surgical System, Teleflex Incorporated, USA) that represents a significant advance in minimally invasive surgery.