Utility of an Internal Retractor (EndoGrab) for the Management of the Vesicouterine Ligament during Laparoscopic Radical Hysterectomy

Abstract

Background/Aims: The study aims to prevent serious urologic injury during a radical hysterectomy; we propose that one of the most important procedural steps is the careful management of the vesicouterine ligament (VUL). Patients and Methods: Between January 2013 and October 2014, we used a novel internal retractor in 17 patients undergoing a laparoscopic radical hysterectomy (LRH) for early-stage cervical cancer to obtain and secure a better surgical view. For management of the VUL during the laparoscopic procedure, we routinely used an internal retractor (EndoGrab; Virtual Ports, Misgav, Israel) and vessel tape to reposition the ureter in a safe lateral-caudal direction. Results: Using an EndoGrab, we were easily able to reproduce a suitable surgical view that simulated the one obtained by an abdominal route for radical hysterectomy. Using this improved laparoscopic procedure, we completed radical hysterectomies in all 17 cases without a ureteral injury complication. Conclusion: Our modified method using an EndoGrab is effective for the prevention of ureteral injury during a LRH, and its ease of use makes it suitable even for those surgeons early in their laparoscopic learning curve.

An atraumatic retractor for interdisciplinary use in conventional laparoscopy and robotic surgery

“…Besides, it is a disposable instrument and appears to be less flexible than other retraction devices. It also calls for complete exposure -similar to that in open surgery -before it can be used on specific target tissue [5]. No retraction device offers the advantages of the ALKATOUT retractor [15,16].…”

“…A variety of endoscopic retractors have been developed by bowel surgeons. All of these are costly, complex in terms of usage and cleaning, and impractical for daily use [4][5][6]. The assistant surgeon is occupied with handling the retractor or keeping tissue away from the operating field, which signifies an unsettled surgical setup.…”