897 SCARLESS MICROPORT AUGMENTED RESTORATION OF TRIANGULATION (SMART) SURGERY: A NEW SURGICAL PARADIGM

摘要

You have accessJournal of UrologyTechnology & Instruments: Robotics/Laparoscopy/Ureteroscopy II1 Apr 2010897 SCARLESS MICROPORT AUGMENTED RESTORATION OF TRIANGULATION (SMART) SURGERY: A NEW SURGICAL PARADIGM D. Duane Baldwin, Daniel Greene, Paymohn Mahdavi, Nathaniel Krupp, Joshua Chamberlin, and Kamyar Ebrahimi D. Duane BaldwinD. Duane Baldwin More articles by this author , Daniel GreeneDaniel Greene More articles by this author , Paymohn MahdaviPaymohn Mahdavi More articles by this author , Nathaniel KruppNathaniel Krupp More articles by this author , Joshua ChamberlinJoshua Chamberlin More articles by this author , and Kamyar EbrahimiKamyar Ebrahimi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1653AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoendoscopic single-site surgery (LESS) produces an excellent cosmetic outcome, but is technically challenging with a steep learning curve that has limited its application in urologic surgery. The objective of this study was to test the feasibility of a novel surgical paradigm that produces a scarless outcome but restores triangulation. METHODS Two SMART (Scarless Microport Augmented Restoration of Triangulation) nephrectomies were performed in the porcine model. In the SMART procedure a single 2.5 cm umbilical incision is made. Three additional 2 mm ports were placed in a diamond configuration. Specialized instruments were developed that are assembled trans-corporeally thereby providing the functionality of a 5 mm or 10 mm instrument with only a 2 mm skin incision. A 10 mm camera was brought in through the umbilical incision but suspended and directed with a 2 mm shaft thereby allowing optimal camera positioning. Only hilar ligation and renal entrapment required use of the umbilical port. All other portions of the case including camera visualization, dissection, cauterization, retraction and suction were performed through 2 mm ports using SMART technology. RESULTS Two porcine SMART nephrectomies were completed with no complications and a mean operative time of 99 minutes (82, 115 minutes). The SMART suction device was able to suction at 886cc/min in saline and 811cc/min in blood (Hct 36%). The SMART suction device also functioned better as a retractor allowing 5-10 x more force application to liver and kidney without injury compared to a conventional 2 mm suction device (p<0.05). The hook electrode was able to perform all aspects of dissection. The visualization provided by the camera was adequate for all steps of renal dissection including hilar transection. The restoration of triangulation made this technique easy to learn and subjectively improved surgeon comfort compared to LESS. CONCLUSIONS SMART represents a new paradigm for scarless minimally invasive surgery. This study demonstrates the feasibility of SMART in the porcine model. By assembling the instruments trans-corporeally, larger more functional instruments are created that pass through a 2 mm skin incision. By restoring triangulation, SMART technology could be used to simplify both LESS and NOTES without altering the nearly scarless cosmetic outcome. Loma Linda, CA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e351 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information D. Duane Baldwin More articles by this author Daniel Greene More articles by this author Paymohn Mahdavi More articles by this author Nathaniel Krupp More articles by this author Joshua Chamberlin More articles by this author Kamyar Ebrahimi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...