Instrumentation for laparoscopic renal surgery--Padron Endoscopic Exposing Retractor (PEER) and Endoholder: point of technique

Innovative technique for gastric retraction during laparoscopic distal pancreatectomy: the marionette

Laparoscopic distal pancreatectomies became more common in the past few years as a safe and effective treatment option for benign and low-grade malignant tumors of the body and tail of the pancreas. Adequate exposure and wide operative field are crucial to perform this procedure, and this is achieved by retraction of the stomach with an angled liver retractor or a grasper through a subxiphoid trocar, that is usually used only to this purpose. We developed an innovative technique to retract the stomach during laparoscopic distal pancreatectomies that provides excellent operative field and frees the subxiphoid trocar to be used in other tasks during the surgery.

Single access laparoscopic nephrectomy

Laparoscopic nephrectomy has assumed a central role in the management of benign and malignant kidney diseases. While laparoscopy is less morbid than open surgery, it still requires several incisions each at least 1-2 cm in length. Each incision carries morbidity risks of bleeding, hernia and/or internal organ damage, and incrementally decreases cosmesis. An alternative to conventional laparoscopy is single access or keyhole surgery, which utilizes magnetic anchoring and guidance system (MAGS) technology or articulating laparoscopic instruments. These technical innovations obviate the need to externally space trocars for triangulation, thus allowing for the creation of a small, solitary portal of entry into the abdomen. Laboratory and early clinical series demonstrate feasibility as well as safe and successful completion of keyhole nephrectomy. Future work is necessary to improve existing instrumentation, increase clinical experience, assess benefits of this surgical approach, and explore other potential applications for this technique.

Efficacy of early use of snake retractor in retroperitoneoscopic nephrectomy or nephroureterectomy

BACKGROUND AND PURPOSE

A snake retractor is generally used to create a better surgical field and space, but when to start using it is still controversial. In this study, we used a snake retractor starting in an early stage of the procedure to safely perform surgery and compared the results with a control group in which the procedure depended on operator discretion.

PATIENTS AND METHODS

Twelve patients were enrolled in this study and compared with a control group (n = 12) in which no special technique was used. We used four ports in both right- and left sided cases and used a snake retractor when removing the flank pad to create a better surgical space and field. We compared two groups in operative time, intraoperative blood loss, and body mass index (BMI).

RESULTS

Three surgeons were enrolled. In the intervention group (early use of snake retractor), operative time was 107 to 300 minutes (median 162 min), and intraoperative blood loss was 0 to 462 g (69.5 g). In the control group, operative time was 185 to 485 minutes (258 min) and intraoperative blood loss was 0 to 302 g (40 g). Operative time was significantly shorter in the intervention group than the control group (P = 0.0034). There was no significant correlation with intraoperative blood loss volume and BMI in these two groups. We did not have any patients with metastasis or recurrence of cancer in either group in post-operative follow-up. Only the control group included a case with a slight duodenum injury.

CONCLUSIONS

Early use of the snake retractor in retroperitoneoscopic nephrectomy or nephroureterectomy may produce a significantly safer operative procedure.