Comparison of laparoscopic steerable instruments performed by expert surgeons and novices

As an alternative to the surgical robot, some medical companies have engineered new steerable devices that mimic the robot's capacities. This study aimed to assess how steerable instruments ameliorate the efficacy of suturing in comparison with the traditional instrument, and a combination instruments, performed by experienced and novice surgeons. The study was performed by three experienced surgeons and three novice surgeons. The instruments employed were divided into three surgical sets: two steerable dissectors; one steerable dissector and one straight needle ; two straight needle holders. The study supervisor recorded the total time for the procedure, the number of bites completed, the time for each bite, and the quality of the procedure. In our study, we found consistent data demonstrating that experienced laparoscopists completed the prescribed suture pattern with more bites in less time than novices. The use of two steerable instruments was more time consuming than standard straight instruments, but a combination of instruments was significantly less time consuming, as was the use of two straight needle holders. This result was even observed in novice surgeons. Combining a steerable instrument with a traditional straight needle holder provided more advantages in this study

Effects of GLUBRAN-2 on the Burst Pressure of Jejunal Loops Thermofused With Vessel Sealing Devices

Background: Off-label use of radiofrequency vessel sealing devices for intestinal thermofusion has been reported as an alternate approach for closing the small and large intestines. The study aimed to evaluate if reinforcing the thermofusion line with a modified N-butyl-2-CyanoAcrylate and methacryloxysulpholane produced improved burst pressure values in ex vivo swine jejunal loops. Materials and Method: A suture-less full-thickness jejunal biopsy was performed with different radiofrequency vessel-sealing devices (Ligasure 5 mm: RFVS-1; Atlast 10 mm: RFVS-2; Cayman Maryland: RFVS-3), and reinforcement with modified cyanoacrylate Glubran-2 (G2) at the thermofusion defect was applied. Burst pressure(BP) values were compared with a control group, wherein a cold blade was utilized to obtain the biopsy, followed by the closing of the jejunum with seven Gambee sutures. Results: Seventy (n = 70) jejunal loop samples were distributed into the experimental groups.The RFVS-1 and -2 groups exhibited BP values similar to those of the suture group. The RFVS-3 group showed significantly lower BP values (P < 0.05) than the suture group. Conversely, in the groups wherein G2 was applied, all BP values were comparable to those of the suture group. BP test in the RFVS-3G2 group showed significantly (P < 0.05) higher values in the group using the same instrument without the glue (RFVS-3). Conclusions: G2 has been shown to improve the BP on the defects created by instruments that are not completely efficient in intestinal thermofusion and sealing. This experimental model showed that the performance of full-thickness biopsies with RFVS devices and reinforcement with G2 provide feasible and promising results

Swine small intestine sealing performed by different vessel sealing devices: Ex-vivo test

This study aimed to evaluate the sealing quality of swine small intestine using different laparoscopic radiofrequency vessel sealing devices (two 5 mm: RFVS-1 and -2; one 10 mm: RFVS- 3) and a harmonic scalpel (HS) compared to golden standard closure technique. The study was divided into two arms. In study arm 1: n = 50 swine intestinal loops (10 per group) were transected with each instrument and the loops in which the devices provided complete sealing, at the gross inspection, were tested for maximum burst pressure (BP) and histological evaluation and compared to an automatic linear stapler. After the BP tests, the devices that achieved significantly lower BP values were excluded from the second arm. The RFVS-1 and -3 provided statistically significant results and were used in study arm 2, to obtain full-thickness biopsies along the antimesenteric border of the loop and were compared with hand-sewn intestinal closure (n = 30; 10 per group). The biopsies were histologically evaluated for thermal injury and diagnostic features, and intestinal loops tested for BP. RFVS-3 achieved comparable results (69.78 ± 4.23 mmHg, interquartile range (IQR) 5.8) to stapler closing technique (71.09 ± 4.22 mmHg, IQR 4.38; p > 0.05), while the RFVS-1 resulted in significantly (p < 0.05) lower BP (45.28 ± 15.23 mmHg, IQR 24.95) but over the physiological range, conversely to RFVS-2 (20.16 ± 7.19 mmHg, IQR 12.02) and HS (not measurable). RFVS-3 resulted not significantly different (p > 0.05) (45.09 ± 8.75 mmHg, IQR 10.48) than Suture (35.71 ± 17.51 mmHg, IQR 23.77); RFVS-1 resulted significantly lower values (23.96 ± 10.63 mmHg, IQR 9.62; p < 0.05). All biopsies were judged diagnostic. Data confirmed that RFVS-1 and -3 devices provided suitable intestinal sealing, with BP pressures over the physiological range. Conversely, the HS and RFVS-2 should not be considered for intestinal sealing. RFVS devices could be employed to obtain small intestine stump closure or full-thickness biopsies. However, further studies should be performed in live animals to assess the role of the healing process

Wound Retractor Laparoscopic Port System for Standing Laparoscopic Cryptorchidectomy in the Horse: A Case Report

Cryptorchidectomy is the most commonly performed laparoscopic procedure in horses. However, its use for the extraction of an abdominal testis has disadvantages such as loss of a resected testis from grasp and fragmentation of the specimen because of the excessive tension required for extraction through a thick body wall. The ring wound retractor laparoscopic port system was recently used in human and small animal surgery to perform laparoscopic-assisted procedures and retrieve large specimens from the abdomen. In the present case, the wound retractor was placed as the ventral port in the right flank through a minilaparotomy. Thereafter, the cap with the gas inlet and instrument port was connected. The other two ports were placed dorsally using 10-mm stainless steel cannulas. Grasping forcep was introduced through the ventral port, and the laparoscope and vessel-sealing devices were introduced through the dorsal ports. After the testis was resected, it was retrieved from the abdomen through the retractor without the grasping forceps jaw being released. This is the first case report describing the use of the wound retractor laparoscopic port system for standing cryptorchidectomy in a horse. This system can be a feasible and safe option for flank laparoscopy in horses, and it facilitates specimen retrieval from the abdominal cavity, but further studies should confirm this preliminary report