Magnets and Secured Independent Tools (SIT) in Laparoscopy

1. Laparoscopy Transportation
Using Magnets and Tramways
Daniel A. Tsin, MD (1),
Guillermo Dominguez, MD (2),
Fausto Davila, MD (3),
Andrea Tinelli, MD (4),
Martha R. Davila, MD (5),
Marcelo Martinez Ferro, MD (2)

2. •The Mount Sinai Hospital of Queens; Long Island City, New
York, USA.
•Fundación Hospitalaria; Buenos Aires, Argentina.
•Universidad Autonoma de Mexico, Facultad de Estudios
Superiores; Iztacala, Mexico.
•Vito Fazzi Hospital, Department of Obstetrics & Gynecology,
Division of Experimental Endoscopic Surgery, Imaging,
Technology and Minimally Invasive Therapy; Lecce, Italy.
•Universidad Nacional Autonoma de Mexico (UNAM), GEA
Gonzalez Hospital, DF, México

3. Disclosure of Interest
Dr. Guillermo Dominguez founder of
IMANLAP reports that this financial
relationship had no influence on the
outcome or content of this paper.
Other authors have no financial
interests to disclose.

4. Presented at the Annual Meeting and
Endo Expo of the Society of
Laparoendoscopic Surgeons.
SEPTEMBER 5–8, 2012, BOSTON,
MASSACHUSETTS, USA

5. Background:
This paper presents a means of intra-abdominal transportation without additional laparoscopy ports.
Methods:
We performed a single incision laparoscopy cholecystectomy using an operative laparoscope with an
operative channel. An alligator clip in tandem with a neodymium magnet was introduced in the
abdomen and placed on the target. A double tether alligator (Secured Independent Tool) was
introduced using two 18 gauge IV catheters strategically placed under laparoscopic surveillance. A
suture was threaded through the IV catheter and identified with the endoscope as it entered the
cavity. The suture was grasped and withdrawn until exiting via the operative port; this maneuver was
done twice. Outside the port, the sutures were tied to the Secured Independent Tool. The Secure
Independent Tool was introduced and placed on the target.
Results:
The magnet was used to hold the fundus of the gallbladder and transport the endobag. The Secured
Independent Tool was used for exposure, mobilization and transportation of the gallbladder. No
perforation of the gallbladder occurred and all functions were done successfully.
Conclusions:
Magnet transportation in the anterior peritoneum was unlimited in this case. The strategically placed
IV catheters allow for an aerial type of tramway transportation of a target between two points inside
the abdomen.

6. MAGNETS

7. Tramway - Teleferico

8. A: Internal
Magnet
B: Alligator Clip
Applier
C: External
Magnet and the
Articulated Arm
Semin Pediatr Surg. 2011 Nov;20(4):224-31.
The use of magnets with single-site umbilical laparoscopic
surgery.
Padilla BE, Dominguez G, Millan C, Martinez-Ferro M.

9. Alligator clip applier opening the jaws

10. During a Transvaginal Cholecystectomy

11. During a Transvaginal Cholecystectomy

12. Transvaginal operation of a Large Liver Cyst

13. After de-roofing, the internal magnet transported the specimen to the pelvis in order to
facilitate the vaginal extraction. We see the roof of the liver cyst with the attached
magnet

14. “Secured Independent Tools (SIT) is changing the
Laparoscopy paradigm. “
Laparoscopy SIT
1 port per instrument. Multiple instruments
per port.
Cannulas.  Threads or Cables.
The diameter of the port The diameter of the
is larger that the cable or thread is
instrument. smaller that the
instrument.

15. The intravenous catheter is thread with a 2-0 prolene, which
is grasped and withdrawn via a 12 mm port . The end is
then tied to an alligator clip. To make a tramway, 2
intravenous catheters must be placed at strategic points.
J Laparoendosc Adv Surg Tech A. 2012 May;22(4):397-9. Epub 2012 Mar 6.
Transabdominal wall deployment for instruments, lights, and
micromotors using the concept of secured independent tools.
Tsin DA, Davila F, Dominguez G, Tinelli A, Davila MR.

16. Laboratory experience using a single incision port and an
endoscopic bulldog clamp

17. Tramway in a simulator

18. A: Operative laparoscope with a 6 mm working channel . B: Curved roticulating grasper
C: 12 mm port . D: 5 mm flexible port . Both ports are placed in the umbilicus

19. The first intravenous catheter is placed medially at a strategic point

20. This is the internal view of the needle and catheter

21. The Catheter is threaded with a 2-0 prolene suture

22. The second catheter is placed to allow the tramway to run between the
two points of entrance

23. Both sutures were tied to the alligator

24. The alligator was placed at the base of the gallbladder using the
alligator clip applier

25. Exposure achieved with the SIT tramway

26. Exposure continues during the procedure

27. The alligator is moved cephalic and medial

28. Two means of transportation, the magnet at the fundus and the SIT at
the base of the gallbladder

29. The magnet was released from the fundus and is now transporting an
endoscopic bag

30. Here is another view of the magnet transporting the endoscopic bag

31. A companion video is available on YouTube:
Laparoscopy Transportation Using Magnets
and Tramways – YouTube
www.youtube.com/watch?v=AGxbtyJgcvE

32. Thank You for your Attention