Retraction Device Research Articles

Laparoscopic nephrectomy for massive polycystic kidney disease: Updated technique and outcomes.

We present our technique of laparoscopic nephrectomy for massive polycystic kidneys in patients with autosomal dominant polycystic kidney disease (ADPKD) and review the outcome analysis of our experience. We retrospectively reviewed all transperitoneal laparoscopic nephrectomies done for polycystic kidneys at a university hospital. Our technique included three 12-mm ports with additional one or two 5-mm ports, with usage of retraction devices, such as the Jarit PEER retractor (J. Jamner Surgical Instruments, Inc, Hawthorne, NY). In total, 39 (left 14, right 25) laparoscopic nephrectomies were performed in 32 patients (male 21, female 11). Surgical indications were varied: to create space for future renal transplant in 21 (54%), to alleviate pain in 16 (41%), to prevent recurrent urosepsis in 2 (5%), to prevent recurrent bleeding which would require transfusions in 2 (5%) and to remove a renal tumour in 1 kidney (2.5%). Four patients had surgery for more than one reason. The mean age and body mass index were 52.2 years (range: 29-72) and 26.9 kg/m(2) (range: 21.6-34.0), respectively. The mean preoperative hemoglobin and serum creatinine levels were 131.6 g/L (range: 107-171) and 514 µmol/L (range: 84-923), respectively; 26 (81%) patients were on dialysis. The mean operative time and estimated blood loss were 185 minutes (range: 113-287) and 94 mL (range: 10-350), respectively. No patient required open conversion. The mean specimen size was 24.2 cm (range: 15-38); weight 1515 g (range: 412-4590) and the length of extraction incision was 9.2 cm (range: 6-13). There were 1 Grade 2 2 (2.5%), 2 Grade 3b (5%) and 1 Grade 4a-d (2.5%) complications. The mean length of stay was 4.5 days (range: 3-8). Our technique of laparoscopic nephrectomy for massively enlarged polycystic kidneys in ADPKD is safe and offers all the advantages of minimal access surgery, such as smaller incision, decreased estimated blood loss, excellent cosmesis and faster recovery.

Clinical experience with a simple retraction device in single-port laparoscopic cholecystectomy: Technical description and initial results

Background: Performing single-port laparoscopic cholecystectomy (SPLC) is challenging as triangulation is limited and the critical view is difficult to obtain. We present our initial experience using a simple retraction device to reduce these problems. Material and methods: In January 2012 a novel lifter was introduced at our department and subsequently used in SPLC for suspension of the gallbladder. Perioperative data were collected prospectively. In addition, all videos were reviewed to assess any adverse events caused by the lifter. Results: Thirty (20 female and 10 male) patients at a median age of 48.4 years (range: 23–83) were operated using this novel retraction device. Median BMI accounted for 26.0 kg/m2 (median; range: 14.0–36.9). Retraction of the gallbladder using the lifter was possible in all patients. In four cases (13.3 %) spillage of bile caused by the lifter was recorded. In addition, perforation of the gallbladder was seen once (3.3 %), caused by electrocautery. No inflammation, induration or visible scars were seen in the right upper quadrant at six weeks postoperatively in any patient. Conclusions: Gallbladder retraction in SPLC using this novel device is feasible and safe without leaving any apparent scar. Rate of bile spillage is (at least) comparable to that reported for conventional laparoscopic cholecystectomy.

Initial Experiences of a Novel Self-Retaining Intracorporeal Retractor Device for Urologic Laparoendoscopic Single-Site Surgery

Laparoendoscopic single-site surgery (LESS) is a surgical option for a number of urologic operations, although it does carry technical limitations. One of the major obstacles in performing LESS is accomplishing optimal retraction of adjacent organs. The aim of this study was to investigate the feasibility of a novel self-retaining intracorporeal retractor device, the Internal Organ Retractor (IOR), and to describe our experience using this device in LESS. A total of 23 patients who underwent LESS using IOR between December 2012 and July 2013 were identified. Among these patients, 11 nephrectomies, 9 adrenalectomies, 1 pyeloplasty, and 2 nephroureterectomies were performed. Perioperative outcomes including operative time, complications related to use of the IOR, and amount of time needed for the application and removal of the IOR were measured during each operation. Adequate retraction was accomplished in all surgical cases. The IOR helped to maintain a consistent operative field throughout the surgery. A median application time of a single IOR was 85.0 (range 44.5-187.5) seconds and removal time was 50.0 (20-400) seconds. The median number of IOR sets used was 2.0 (range 1-4), and the median total application and removal time in a single operation were 170.0 (45-750) seconds and 95.0 (20-400) seconds, respectively. There were no perioperative complications associated with use of the IOR. The IOR provided satisfactory retraction during LESS, and its application/removal was uncomplicated and needed a minimal amount of time. The IOR reduced the need for additional laparoscopic ports for retraction. We believe that the IOR is a useful retraction tool for LESS and possibly multiport laparoscopic surgeries.

Staged gastroschisis closure using Alexis wound retractor: first experiences

The aim of this study is to analyze the effectiveness of an Alexis wound retractor (AWR) device for staged gastroschisis closures. AWR device was used to cover unreduced viscera of a gastroschisis when primary abdominal wall closure was not convenient. The eviscerated organs were covered with one of the two spring-loaded rings of the AWR inserted underneath the abdominal wall. Gradual reduction was guaranteed through careful traction on the external ring. We retrospectively analyzed the prenatal, post-natal and operative data of the first patients treated with AWR and report their post-operative outcomes. The AWR device was used for staged closure in eight cases. Complete reduction and fascial closure were performed at a median of 3.5 ± 1.6 days. Ventilatory support was necessary for 4.0 ± 3 days and full parenteral feeds for 7.5 ± 6.1 days after fascial closure. Median full enteral feeding was observed at 18 ± 12.5 days after closure allowing discharge in a median period of 30.5 ± 15.6 days after closure. The AWR device is not only a safe and efficient silo for a progressive reduction of severe gastroschisis, but also an interesting tool for continuous stretching leading to an increase of the peritoneal cavity volume, enhancing the equalizing of the viscero-abdominal disproportion.

A Novel Totally Internal Laparoscopic Liver Retractor

Minimally invasive surgery is still in evolution. Throughout the past two decades numerous devices have been developed to enable safer and faster procedures, including anastomosis creating devices, energy sources, and superior imaging. However, retraction capabilities were put aside and currently, organ laparoscopic retraction is based on standard laparoscopic tools. In the era of minimizing the number of ports and shrinking their size, our aim was to develop internal retraction device that could be placed in the peritoneal cavity through a standard trocar, positioned for adequate retraction, and left in place for the entire procedure. These devices would obviate the need for inserting ports dedicated for retraction only and hence contribute to the reduction of the number of incisions. Herein, we present our initial experience with a novel internal liver retractor. The Endolift retractor is a simple telescopic rod that has anchoring claws at each end. It can be inserted using 5 mm standard trocar using a dedicated applier and anchored to the peritoneum beside the liver edges thereby lifting the undersurface of the liver and exposing the organs underneath. To achieve retraction of the left lateral segment, the Endolift retractor is anchored lateral to the right diaphragmatic crus on 1 side and lateral to the falciform ligament on the other. A total of 14 operations were performed using the Endolift retractor for liver retraction including antireflux procedure, robotic-assisted Heller's myotomy, bariatric procedures, and bile duct exploration. The left lobe of the liver was adequately retracted and enabled access to the operating field. Repositioning was easily performed with progression of the surgery when necessary. Internal retraction devices such as the Endolift retractor for liver retraction are one step further in minimizing trauma to the abdominal wall during minimal invasive surgery. It obviates the need for extra incisions, frees up the surgeons' hands, and may enable performing complicated laparo-endoscopic single-site laparoscopy and natural orifice transluminal endoscopic surgery.

A novel liver retractor for reduced or single-port laparoscopic surgery

Retraction of either lobe of liver is required for surgical access to the respective organ. A novel liver retractor device and technique is described, which applies a vacuum between the liver and diaphragm to lift the liver, and which does not require additional incisions. A novel liver retractor was tested in two anesthetized sheep at incrementally higher levels of suction from -100 to -700 mmHg (-13 to -93 kPa), and any signs of trauma were recorded. The animals recovered for 5 days, then were humanely killed and postmortem examination of the liver and diaphragms performed. Successful liver retraction was achieved from -200 to -600 mmHg (-27 to -80 kPa) suction. An imprint of the retractor was observed on the liver surface, but there was no breach of the liver serosa. Negligible ecchymoses were observed on the corresponding surface of the diaphragms. Both sheep recovered well after surgery. There was no macroscopic evidence of injury to the liver and diaphragm 5 days postoperatively. Histological examination revealed normal liver parenchyma deep to the site where the devices had been placed, and hemorrhagic changes within the serosa only varied between a few microns to a maximum of 1.4-mm depth. The novel liver retractor described achieved an effective liver retraction without trauma. It has potential application in reduced or single-port laparoscopic upper abdominal surgery.

Design, Development, and Evaluation of a Novel Retraction Device for Gallbladder Extraction During Laparoscopic Cholecystectomy

BackgroundA source of frustration during laparoscopic cholecystectomy involves extraction of the gallbladder through port sites smaller than the gallbladder itself. We describe the development and testing of a novel device for the safe, minimal enlargement of laparoscopic port sites to extract large, stone-filled gallbladders from the abdomen. MethodsThe study device consists of a handle with a retraction tongue to shield the specimen and a guide for a scalpel to incise the fascia within the incision. Patients enrolled underwent laparoscopic cholecystectomy. Gallbladder extraction was attempted. If standard measures failed, the device was implemented. Extraction time and device utility scores were recorded for each patient. Patients returned 3–4 weeks postoperatively for assessment of pain level, cosmetic effect, and presence of infectious complications. ResultsTwenty (51 %) of 39 patients required the device. Average extraction time for the first eight patients was 120 s. After interim analysis, an improved device was used in 12 patients and average extraction time was 24 s. There were no adverse events. Postoperative pain ratings and incision cosmesis were comparable between patients with and without use of the device. ConclusionThe study device enables safe and rapid extraction of impacted gallbladders through the abdominal wall.

Natural orifice translumenal endoscopic surgery: Current status and future technical development

The technology behind NOTES, an evolutionary endoscopic surgery conducted through the natural orifices of the patient to completely eliminate external post-operative scars, has been substantially improved in the last decade. The scarless nature of NOTES is believed to decrease the chance of wound infections and incision hernias, improve recovery times and increase the cosmetic satisfaction of patients. Although various animal and human studies have extended our understanding of physiology and the requirements of NOTES procedures, current NOTES technology is still too rudimentary to be applied to various clinical settings due to the technical and instrumental limitations. Recently, numerous efforts have been made in the development of proper surgical instruments for NOTES procedures. A secure closure method for luminal perforation is one of the most actively investigated areas, and several promising devices have already been introduced. A virtual navigation system for flexible endoscopic instruments would be beneficial for surgical reliability and safety issues by assisting the narrow endoscopic visual field. Various retraction devices are also necessary to enable complex endoscopic surgical maneuvers. Unfortunately, engineers have only taken supportive roles in the history of NOTES development, though engineering experience and knowledge are crucial for the development of complicated and miniaturized endoscopic devices. The active involvement of engineers in NOTES technology is required for the realization of NOTES in routine clinical practice.

Evaluation of Laparoscopic‐Assisted Ovariohysterectomy for Treatment of Canine Pyometra

To describe a technique for treating pyometra in dogs using a 3-portal laparoscopic-assisted ovariohysterectomy (LAOVH) and evaluate outcome. Retrospective case series. Dogs (n = 12). Dogs with open or closed-cervix pyometra with moderately sized (1-4 cm) uterine horn diameters based on preoperative ultrasonography and no evidence of perforation were included in the study. A 3-portal technique for LAOVH was used. A wound retraction device was inserted into the caudal portal after enlargement of the incision to 3-4 cm to simplify removal of the uterus with minimal tension. Twelve dogs (median weight, 23.3 kg; range, 2.1-46.0 kg) met the inclusion criteria. Median uterine diameter was 3.0 cm (range, 1.2-4.0 cm). Median surgical time for LAOVH was 107 minutes (range, 82-120 minutes). Complications included mild hemorrhage from the uterine vessels in 1 dog during uterine removal through the wound retraction device and intra-abdominal uterine rupture in 1 dog which necessitated conversion to an open approach. All dogs recovered from surgery and were discharged. LAOVH can be used for treatment of select cases of canine pyometra. Careful case selection is mandatory to improve success and minimize conversion to an open approach. Gentle handling of the reproductive organs is imperative to avoid iatrogenic uterine rupture.

The Three-Trocar Laparoscopic Pyeloplasty: Tips and Tricks on Technical Aspects

Introduction: Laparoscopic pyeloplasty (LP) is the first-line option for management of ureteropelvic junction obstruction (UPJO).1,2 Initially, this procedure was described using four or five ports; however, newer approaches use three-trocars aiming for minimal invasión,3,4 which may complicate the procedure. We present a video of the three-trocar technique step by step, with several tips and tricks to improve the performance. Patients and Methods: Seven patients (mean 44 years old range: 31–58) underwent Anderson-Hynes three-trocar LP for symptomatic UPJO. The three-port transperitoneal technique was done. A 10-mm trocar was placed directly through the umbilicus and two 5-mm trocars in a triangular arrangement. To improve exposure of the UPJ and reduce the dissection time, the surrounding tissues may be retracted with clips or sutures applying the puppet maneuver, with special caution to avoid incorporating the bowel into the retraction devices. The proximal ureter may be lifted with similar maneuver, like a suture sling to simplify the UPJ dissection and further on the spatulation.5 In some cases, kidney stones may be removed using a nephroscopy with carbon dioxide (CO2), inserting a flexible cystoscope into the renal pelvis. This technique may be applied to avoid accumulation of irrigation fluid into the peritoneal cavity, connecting the gas cannula to the irrigation channel of the endoscope to insufflate CO2. It works well for stones located in the anterior calicos, but is not useful in the posterior calicos.6 The ureteral spatulation may be simplified through stabilization of UPJ by the remaining attachment to the renal pelvis, by the suture sling of the ureter and by a grasper holding.7 The performance of the dismembered pyeloplasty may be improved and simplified applying the Hammock maneuver, which stabilizes the line of anastomosis anchoring the suture to the surrounding tissues with clips, with caution to avoid incorporating the bowel again. Finally, the percutaneus antegrade ureteral stent placement may be done through a 14-gauge angiocatheter,8,9 previous to complete the anastomosis. Results: The average operating time of the pyeloplasty was 187 minutes. No open conversions were required. There were no perioperative complications. Subjective and objective success was obtained in six of seven patients. Conclusions: The three-trocar LP is a secure and feasible technique for the correction of UPJO. The maneuvers shown in this video may simplify the procedure. No competing financial interests exist. Runtime of video: 9 mins 49 secs

Single-incision Laparoscopic Cholecystectomy

To maintain operative safety, patient selection criteria for single-incision laparoscopic cholecystectomy (SILC) are more stringent than that for traditional laparoscopic cholecystectomy (TLC). No other method could demonstrate the same feasibility and safety as TLC because the patient selection criteria were too restrictive for SILC to compare with TLC. In this study, we conducted a comparative study between our original SILC and TLC for demonstrating similar feasibility and safety among patients who had the same selection criteria as that for TLC. A statistical comparison between 114 patients of SILC and 201 patients of TLC was conducted during the same time period. The preoperative patient characteristics for SILC and TLC showed no statistical difference. In the operative result analysis, a significant disadvantage of SILC was the prolongation of operative time by only 15 minutes. The original SILC was as feasible and safe as TLC and virtually scarless cholecystectomy could be performed without any selection criteria. This was performed using only 2 trocars from an umbilical incision and 2 incisionless extracorporeal retraction devices.

Prospective intra-patient evaluation of a shoulder retraction device for radiotherapy in head and neck cancer

Irradiation of tumors in the larynx and pharynx is often technically challenging in patients with a short neck or high shoulders. Shoulder retraction devices can sometimes resolve this problem and allow irradiation via lateral beam directions. This study aimed to measure the proportion of patients who would benefit from such an approach and to quantify the magnitude of the benefit obtained. Twenty patients were studied. Simulator images were obtained before and after intervention. The additional exposure of the cervical spine was measured. Patient comfort and acceptability were assessed with a questionnaire. Improvement of exposure of the cervical spine was observed in 80% of patients. In 20%, there was either no difference or the position was worse. Shoulder retraction exposed a mean of 8.4–10.2 mm more of the cervical spine. Patients in general reported the device as comfortable. The use of a shoulder retraction device produced clinically significant improvements in exposure of the tissues of the cervical spine and neck and should be considered in patients being irradiated for tumors arising in the larynx or hypopharynx.

Treatment of Intracranial Aneurysms Using Flow-Diverting Silk Stents (BALT): A Single Centre Experience

The Silk stent (Balt, Montmorency, France) is a retractable device designed to achieve curative reconstruction of the parent artery associated with an intracranial aneurysm. We present our initial experience with the Silk flow-diverting stent in the management and follow-up of 25 patients presenting with intracranial aneurysms.Twenty-five patients (age range, 34-81 years; 24 female) were treated with the Silk flow-diverting device. Aneurysms ranged in size from small (5), large (10) and giant (10) and included wide-necked aneurysms, multiple, nonsaccular, and recurrent intracranial aneurysms. Nine aneurysms were treated for headache, 14 for mass effect. None presented with haemorrhage. All patients were pretreated with dual antiplatelet medications for at least 72 hours before surgery and continued taking both agents for at least three months after treatment. A total of 25 Silk stents were used. Control MR angiography and/or CT angiography was typically performed prior to discharge and at one, three, six and 12 months post treatment. A follow-up digital subtraction angiogram was performed between six and 19 months post treatment.Complete angiographic occlusion or subtotal occlusion was achieved in 15 patients in a time frame from three days to 12 months. Three deaths and one major complication were encountered during the study period. Two patients, all with cavernous giant aneurysms, experienced transient exacerbations of preexisting cranial neuropathies and headache after the Silk treatment. Both were treated with corticosteroids, and symptoms resolved completely within a month.In our experience the Silk stent has proven to be a valuable tool in the endovascular treatment of intracranial giant partially thrombosed aneurysms and aneurysms of the internal carotid artery cavernous segment presenting with mass effect. The time of complete occlusion of the aneurysms and the risk of the bleeding is currently not predictable.

A Wound Retraction Device for Laparoscopic‐Assisted Intestinal Surgery in Dogs and Cats

To report experience with laparoscopic-assisted intestinal resection and anastomosis for treatment of discrete intestinal masses using a novel wound retraction device. Case series. Dogs (n=2) and cats (6). Dogs and cats with discrete intestinal masses identified by ultrasonography without evidence of intestinal perforation or peritonitis, were included. A 2 portal technique was used; 1 portal was enlarged for insertion of the wound retraction device through which the intestine was examined as thoroughly as possible. The diseased portion of the intestine was exteriorized through the wound retractor and resection and anastomosis of the intestinal mass performed. Of the 8 animals, laparoscopic-assisted intestinal resection and anastomosis through the wound retractor was performed in 2 dogs and 3 cats. In 3 cats, based on either location or extent of the lesion, 2 were converted to laparoscopic-assisted intestinal biopsies and 1 to an open colocolostomy. No other intra- or perioperative complications were encountered and all animals survived to discharge. Laparoscopic-assisted intestinal resection and anastomosis can be performed in select canine and feline patients with modestly sized, discrete intestinal masses.

Pregnancy and Outcome of Uterine Allotransplantation and Assisted Reproduction in Sheep

This pilot study was performed from March 2008 through February 2010 to demonstrate that pregnancy can be achieved in a uterine allograft in the sheep model with the guidance of assisted reproductive technology. Uterine allotransplantation was performed in 12 sexually mature African sheep (Sudanese and Ethiopian). All animals underwent uterine transplantation via a minilaparotomy incision using a Mobius retractor device. A control group of pregnant Romney Marsh sheep with nontransplanted uteri were used to compare fetal development, uterine and placental histologic findings, and blood samples of progeny of the uterine transplant recipient sheep. Fetal size was obtained from ultrasound measurements during the early (crown-rump length) and late (biparietal diameter and abdominal circumference) gestational periods. The primary end point variables included preoperative and postoperative management, embryo transfer protocol, intraoperative assessments, and physiologic cardiopulmonary changes in the lamb during the first 5 hours of life. Four months after the initial uterine transplantation, 5 of 12 uterine allografts were considered candidates for the embryo transfer procedure. Fresh and frozen blastocyst donors were transferred accordingly to the remaining 5 uterine allografts via a minilaparotomy incision. Three of these resulted in pregnancies. One was an ectopic gestation, 1 sheep carried the pregnancy to 105 days, and 1 delivered a fully developed lamb from the transplanted uterus that was delivered via cesarean section. Neonatal lamb blood gas values and chemistry, gross organ examination, and ventilation and respiratory compliance studies yielded results normal for gestational age. This first reported case demonstrates that pregnancy can be carried in an allotransplanted uterus, with the end result a successful delivery.

Single-Incision Multiport Laparoscopic Cholecystectomy

To report on our initial experience with single-incision multiport laparoscopic cholecystectomy, together with its clinical outcomes. Nonrandomized prospective study. University department of surgery. Sixty-four patients with gallstones and gallbladder polyps were enrolled after providing informed consent. Based on our experience, we excluded patients with acute cholecystitis, concomitant choledocholithiasis, a history of previous upper abdominal surgery, and a suspicion of gallbladder cancer. We analyzed the outcomes and complications, based on our experience, according to the clinicopathologic and operative factors. We also compared patients who underwent single-incision multiport laparoscopic cholecystectomy with those who were converted to conventional laparoscopic cholecystectomy. There were 2 bile duct injuries and 4 surgical site infections. We had difficulties in visualizing the Calot triangle in 22 patients. Higher levels of inflammatory markers, longer operation times, and more frequent bile juice spillage were significantly observed in those patients. Ten patients were converted to conventional laparoscopic cholecystectomy. The mean age of patients who underwent conversion surgery was significantly older than that of the no-conversion group. The more the body mass index increased, the more the conversion rate increased. Experienced laparoscopic surgeons can safely perform cholecystectomy using conventional and curved laparoscopic instruments in selected patients. We recommend that you consider performing conventional laparoscopic cholecystectomy or that you use additional retraction devices for patients with a higher body mass index or acute cholecystitis.

Laparoendoscopic single-site surgery cholecystectomy using a novel retraction device

Surgical PracticeVolume 14, Issue 3 p. 118-119 Multi-Media Article Laparoendoscopic single-site surgery cholecystectomy using a novel retraction device Anthony Yuen-Bun Teoh, Anthony Yuen-Bun Teoh Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, ChinaSearch for more papers by this authorJeff Siu-Wang Wong, Jeff Siu-Wang Wong Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, ChinaSearch for more papers by this authorPhilip Wai-Yan Chiu, Philip Wai-Yan Chiu Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, ChinaSearch for more papers by this authorPaul Bo-San Lai, Paul Bo-San Lai Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, ChinaSearch for more papers by this authorEnders Kwok-Wai Ng, Corresponding Author Enders Kwok-Wai Ng Email: endersng@surgery.cuhk.edu.hkSearch for more papers by this author Anthony Yuen-Bun Teoh, Anthony Yuen-Bun Teoh Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, ChinaSearch for more papers by this authorJeff Siu-Wang Wong, Jeff Siu-Wang Wong Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, ChinaSearch for more papers by this authorPhilip Wai-Yan Chiu, Philip Wai-Yan Chiu Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, ChinaSearch for more papers by this authorPaul Bo-San Lai, Paul Bo-San Lai Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, ChinaSearch for more papers by this authorEnders Kwok-Wai Ng, Corresponding Author Enders Kwok-Wai Ng Email: endersng@surgery.cuhk.edu.hkSearch for more papers by this author First published: 21 July 2010 https://doi.org/10.1111/j.1744-1633.2010.00500.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume14, Issue3August 2010Pages 118-119 RelatedInformation

Combined suture retraction of the falciform ligament and the left lobe of the liver during laparoscopic total gastrectomy

The inferior surface of the liver's left lobe overlies important structures such as the hepaticoduodenal ligament, the lesser omentum, and the gastroesophageal junction. Exposure of these structures is mandatory during dissection of lymphatic basin when total laparoscopic gastrectomy is performed. This report describes a liver retraction technique using a suture that simultaneously retracts both the falciform ligament and the left lobe of liver. The reported technique involves placement of a suture through the mid pars condensa of the lesser omentum and its retrieval through a single subxyphoid stab wound after one limb has been passed through the avascular segment of the falciform ligament. The end result is a V-shaped formation that maintains the falciform ligament and the left lobe of liver in a retracted cranial and anterior position. In this prospective study, 55 patients (34 men and 20 women) with gastric cancer underwent laparoscopic total gastrectomy using the reported liver retraction technique between August 2008 and November 2009. The mean age of the patients was 59 years (range, 31-86 years), and their mean body mass index (BMI) was 24 kg/m(2) (range, 18.2-31.9 kg/m(2)). The mean time required to complete the procedure was 4 min (range, 3-7 min). All the patients had adequate exposure of the dissection field without the need for an additional retraction device. No failures or complications resulted from this pars condensa suture liver retraction technique. The technique of combined falciform and left lobe of the liver retraction using a single suture is a safe, effective, and efficient method for exposing the hepaticoduodenal ligament, lesser omentum, and gastroesophageal junction in patients undergoing total laparoscopic gastrectomy.

Estudo laboratorial do tempo de fechamento das alças e do grau de inclinação do canino, durante o procedimento de retração, empregando mecânica de arco segmentado

OBJETIVO: avaliar o tempo de retração e o grau da inclinação sofrida pelo canino empregando três tipos de molas ortodônticas para retração - a alça em "T", a alça em "L" e a alça em forma de gota. MÉTODOS: foram utilizados três tipos de fio - aço inoxidável da marca comercial Morelli, aço inoxidável da marca comercial 3M Unitek e liga de beta-titânio da marca comercial Ormco; todos de calibre 0,019" x 0,025". A amostra resultante da combinação dos fatores mola e fio foi submetida à avaliação em modelo de typodont específico para essa finalidade. RESULTADOS: com relação ao tempo de fechamento das alças, verificou-se que um fechamento mais lento, e consequentemente com menor liberação de forças, foi obtido com o desenho de alça em "T" e, ainda, empregando-se a liga de beta-titânio para sua confecção. No que diz respeito à inclinação gerada pelas alças, as alças em forma de gota promoveram uma inclinação dentária maior do que as demais avaliadas. As alças em "T", por outro lado, mantiveram-se relacionadas estatisticamente aos menores valores de inclinação. Porém, quando se empregou o fio de aço inoxidável da marca comercial 3M Unitek para sua confecção, os três tipos de alça não apresentaram diferença estatisticamente significante. CONCLUSÃO: independentemente do desenho de alça empregado, aquelas construídas com liga de beta-titânio mantiveram-se relacionadas estatisticamente aos menores valores de inclinação observados para o elemento dentário movimentado.

The Use of a New Kind of Low Profile Retractor for Arteriovenous Fistula Procedure Simplifies and Speeds up the Intervention

The aim of this study was to demonstrate the effectiveness of a new kind of disposable surgical retractor in arteriovenous fistula (AVF) procedures in order to achieve an easier, faster and safer surgical intervention. Between January and June 2008, 22 AVF procedures were performed using the 3PAWS ReeTrakt (Insightra Inc. - Irvine, Ca., USA) a self-retaining, low profile retractor. An equivalent patient sample, in which an AVF was performed using conventional retraction devices, was considered for comparison of the intra- and post-operative results. In all of the 22 AVF procedures performed, the ReeTrakt system has simplified the performance of the surgical team. The retractors were very easy to place. The view of the operating field was always optimal. The introduction of the surgical instruments was at all times extremely easy and unrestricted. We also noted a reduction in the operating time (from an average of 67 min in controls to 43 min). There were no intra-operative complications. No post-operative complications related to the use of this kind of device occurred. Conversely, the amount of intra- and post-operative complications in the control group managed with conventional retraction devices was marginally higher than in the ReeTrakt patient group. The ReeTrakt system is a very simple and useful low profile retractor for AVF procedures. Its ultra low profile allows a much improved view of the operating field, an unhindered insertion of the surgical instruments and a shortening of intervention time, avoiding the problems which arise as a result of standard retractors typically used during this kind of procedure. Due to absolute perpendicular retraction it offers a highly atraumatic performance, avoiding swelling and marks on the insertion sites. Therefore, in our opinion, it has the potential to reduce the risk of wound oedema, hematomas or infection associated with the AVF procedure. This is important as many patients are elderly with fragile tissues.