Development and clinical application of semi-loop-shaped retractor for gasless laparoscopic surgery

Izumi, Yuko; Kawano, Tatsuyuki; Iwai, Takehisa

doi:10.1007/s00464-002-8768-z

Cited by 8 publications

(9 citation statements)

References 15 publications

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“…Different instruments and techniques have been used in order to accomplish the gasless space away from the potential side effects of pneumoperitoneum and the insufflation of CO 2 such as: Laparolift™ and laparofan, 27 Laparotenser® device, 28,29 traction on straight metal rods, 30 traction on Foley's catheter, 31 the use of a semi-loop-shaped abdominal retractor 32 and the use of towel clips with a ceilingmounted laplift. 33 Some of these instruments are complex, expensive and are not available in all hospitals; others are tedious to mount and assemble with loss of extra time or need extra stab wounds.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of laparoscopic cholecystectomy during pregnancy: A comparative study between low-pressure and gasless laparoscopy

El-Ashry

Mohamed

2009

Ain Shams Journal of Surgery

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Pregnancy and high parity increase the risk of cholelithiasis and its complications during pregnancy. Laparoscopic cholecystectomy for failed conservative treatment of symptomatic cases during pregnancy is no longer been a contraindication. The potential risk of pneumoperitoneal pressure and CO2 insufflation triggered the use of modified techniques as gasless and low pressure cholecystectomy for materno-fetal safety.Patients and methods: Thirteen pregnant patients with indicated cholecystectomy were randomly assigned for either low-pressure laparoscopy (LPL) (6 patients) or gasless laparoscopy (GL) (7 patients). Patients were compared for respiratory and blood gases changes, hemodynamic changes, anesthetic requirements, surgical and early postoperative outcomes and materno-fetal well-being during hospitalization and they were followed up till delivery.Results: After CO2 insufflation there were significant differences between the 2 groups with increase in the cardiopulmonary parameters namely; PaCO2, PetCO2 , peak airway pressure, heart rate and the mean arterial blood pressure and a decrease in pH in the LPL group. The operating time and anesthetic drugs used were significantly more for the GL group. No recorded differences in the postoperative abdominal pain, postoperative nausea and vomiting (PONV) and fetal heart rate changes.Conclusion: Both low pressure and gasless laparoscopy provide a safe technique for laparoscopic cholecystectomy during pregnancy. However, gasless technique is associated with lower cardiopulmonary effects, despite its longer operating time. In patients with compromised cardiopulmonary function during pregnancy, the gasless technique provides a safer method to avoid the potential adverse effects of pneumoperitoneal pressure and CO2 insufflation.

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Section: Discussionmentioning

confidence: 99%

Safety and efficacy of laparoscopic cholecystectomy during pregnancy: A comparative study between low-pressure and gasless laparoscopy

El-Ashry

Mohamed

2009

Ain Shams Journal of Surgery

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“…Previous research has suggested that for an “average” adult patient, the radius of the retractor should be 8.5 cm. 11 However, to achieve optimal exposure in patients of many ages and sizes, retractors of different sizes will be needed. Therefore, a retrospective study was developed to collect cross-sectional computed tomography (CT) data from subjects varying in age and weight.…”

Section: Methodsmentioning

confidence: 99%

“…When several anchoring points are used, this reduces the maneuvering space of the laparoscopist and increases the number of incision sites for the patient. 4,9,11-15…”

Section: Introductionmentioning

confidence: 99%

“…When several anchoring points are used, this reduces the maneuvering space of the laparoscopist and increases the number of incision sites for the patient. 4,9,[11][12][13][14][15] This study describes the development and testing of the KeyLoop retractor, a semicircular, biocompatible, stainless steel retractor for gasless laparoscopic surgery. The KeyLoop can be inserted through a single 5-mm incision at the umbilicus and then counter-rotated beneath the abdominal wall.…”

Section: Introductionmentioning

confidence: 99%

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KeyLoop: Mechanical Retraction of the Abdominal Wall for Gasless Laparoscopy

et al. 2021

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Background. Despite favorable outcomes of laparoscopic surgery in high-income countries, its implementation in low- and middle-income countries (LMICs) is challenging given a shortage of consumable supplies, high cost, and risk of power outages. To overcome these barriers, we designed a mechanical retractor that provides vertical tension on the anterior abdominal wall. Methods. The retractor design is anatomically and mathematically optimized to provide exposure similar to traditional gas-based insufflation methods. Anatomical data from computed tomography scans were used to define retractor size. The retractor is constructed of biocompatible stainless steel rods and paired with a table-mounted lifting system to provide 5 degrees of freedom. Structural integrity was assessed through finite element analysis (FEA) and load testing. Functional testing was performed in a laparotomy model. Results. A user guide based on patient height and weight was created to customize retractor size, and 4 retractor sizes were constructed. FEA data using a 13.6 kg mass (15 mm Hg pneumoperitoneum) show a maximum of 30 mm displacement with no permanent deformation. Physical load testing with applied weight from 0 to 13.6 kg shows a maximum of 60 mm displacement, again without permanent deformation. Retraction achieved a 57% larger field of view compared to an unretracted state in a laparotomy model. Conclusions. The KeyLoop retractor maintains structural integrity, is easily sterilized, and can be readily manufactured, making it a viable alternative to traditional insufflation methods. For surgeons and patients in LMICs, the KeyLoop provides a means to increase access to laparoscopic surgery.

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“…Besides decreasing the pneumoperitoneum pressure, there are techniques for abdominal wall lift so that pneumoperitoneum pressure can be greatly deceased during MIS. 15,16 These involve a retractor system that helps to lift the abdominal wall with assistance from outside the patient, rather than intra-abdominal pressure pushing out uniformly from within the abdomen. Running a brief test in severe Trendelenburg position before prepping will sometimes identify the occasional patient that simply can't tolerate this position for very long.…”

Section: Special Patient Populationsmentioning

confidence: 99%

New technology and patient safety go

Francis¹

2008

OR Nurse

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T The role of the perioperative nurse is unique in regards to the high level of technical skill, in addition to clinical skills, necessary to function. 1 Advancements in technology and minimally invasive surgery (MIS) have introduced many devices into the OR that nurses are responsible for setting up, operating, troubleshooting, tearing down, and storing. Robotic devices are among the latest technologies perioperative nurses are trying to master. There are medical robotic devices used in the specialties of orthopedics, neurosurgery, urology, gynecology, cardiothoracic surgery, general surgery, and peripheral vascular surgery. In addition, research is currently being done for applications in otolaryngology. 2,3 hand in hand

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Development and clinical application of semi-loop-shaped retractor for gasless laparoscopic surgery

Abstract: This new retractor for gasless laparoscopic surgery provides good exposure and has the potential to enhance the performance of advanced laparoscopic surgery.

Cited by 8 publications

References 15 publications

Safety and efficacy of laparoscopic cholecystectomy during pregnancy: A comparative study between low-pressure and gasless laparoscopy

Safety and efficacy of laparoscopic cholecystectomy during pregnancy: A comparative study between low-pressure and gasless laparoscopy

KeyLoop: Mechanical Retraction of the Abdominal Wall for Gasless Laparoscopy

New technology and patient safety go

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