Experimental use of a novel single-port gasless laparoendoscopic operative field formation device

Abstract

IntroductionTraditional laparaendoscopic surgery using CO2 pneumoperitoneum is associated with complications and the existing gasless laparaendoscopic surgery has shortcomings such as poor visibility in the operation field. To overcome the disadvantages of the current lifting gasless laparaendoscopic operation platforms, we developed an inflatable device for gasless laparoscopic operation field formation (LOFF) that can be internally installed and applied in practice.MethodsWe initially designed operation platforms for gasless laparaendoscopic single-port (GLESP) surgery. Subsequently, a triangular prismatic LOFF device was selected and applied successfully to GLESP cholecystectomy of five pigs. Ultimately, using pigs as a model, three surgical approaches (LOFF-assisted laparaendoscopic single-site (LOFF-LESS), LESS surgery, and traditional lifting (GLESP) were compared, and the advantages and drawbacks of inflatable devices for gasless laparoscopic operation field assessed.ResultsThe use of the LOFF device in GLESP cholecystectomy was first evaluated. The time for surgical space formation (4.4 ± 1.2 and 4.8 ± 1.0), the operating time for gallbladder removal (25.2 ± 4.8 and 25.4 ± 2.7), and the loss of blood (9.4 ± 3.1and 9.2 ± 2.4) was similar between LESS and LOFF, respectively (Table 2). In contrast these parameters were higher in GLESP (6.6 ± 1.0, 30.3 ± 4.4 and 10.1 ± 2.0, respectively. The LOFF-LESS surgery exhibited a clearer exposure of the surgical field and shorter operating time than the GLESP surgery. LESS technology showed less postoperation pain, fast recovery, and extremely high cosmetic satisfaction.ConclusionThe LOFF device provides a safe, effective, and feasible operation platform that can be internally installed and inflated for GLESP surgery during cholescytectomy in animal models.

Comparison of a new gasless method and the conventional CO2 pneumoperitoneum method in laparoendoscopic single-site cholecystectomy: a prospective randomized clinical trial

“…With the intention of avoiding the adverse effects of CO 2 pneumoperitoneum and retaining the mini-invasive characteristic of laparoscopic surgery at the same time, we designed a new gasless laparoscopic operation field formation (LOFF) device, which achieved success in large laboratory animal experiments [19] and its safety and efficiency were confirmed in clinical application for cholecystectomy [20]. The LOFF also obtained medical device registration certificate of the people's republic of China (Registration Certificate No.…”

KeyLoop retractor for global gasless laparoscopy: evaluation of safety and feasibility in a porcine model

“…General surgeons and gynecologists in LMICs have described performing basic procedures such as exploratory laparoscopy, cholecystectomies and appendectomies using lift devices. Previous devices to facilitate gasless laparoscopy include retractor systems [ 12 – 14 ], abdominal wall-lifting systems [ 15 , 16 ], inflatable devices [ 17 ], and rope-lifting techniques [ 18 ]. Most of these studies are case reports in human patients.…”