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Laparoscopy Transportation using Magnets and Tramways

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Magnets and Secured Independent Tools (SIT) in Laparoscopy

Laparoscopy Transportation using Magnets and Tramways

  1. 1. Laparoscopy TransportationUsing 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. 2. •The Mount Sinai Hospital of Queens; Long Island City, NewYork, USA.•Fundación Hospitalaria; Buenos Aires, Argentina.•Universidad Autonoma de Mexico, Facultad de EstudiosSuperiores; 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), GEAGonzalez Hospital, DF, México
  3. 3. Disclosure of InterestDr. Guillermo Dominguez founder ofIMANLAP reports that this financialrelationship had no influence on theoutcome or content of this paper. Other authors have no financialinterests to disclose.
  4. 4. Presented at the Annual Meeting andEndo Expo of the Society ofLaparoendoscopic Surgeons.SEPTEMBER 5–8, 2012, BOSTON,MASSACHUSETTS, USA
  5. 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 anoperative channel. An alligator clip in tandem with a neodymium magnet was introduced in theabdomen and placed on the target. A double tether alligator (Secured Independent Tool) wasintroduced using two 18 gauge IV catheters strategically placed under laparoscopic surveillance. Asuture was threaded through the IV catheter and identified with the endoscope as it entered thecavity. The suture was grasped and withdrawn until exiting via the operative port; this maneuver wasdone twice. Outside the port, the sutures were tied to the Secured Independent Tool. The SecureIndependent 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 SecuredIndependent Tool was used for exposure, mobilization and transportation of the gallbladder. Noperforation of the gallbladder occurred and all functions were done successfully.Conclusions:Magnet transportation in the anterior peritoneum was unlimited in this case. The strategically placedIV catheters allow for an aerial type of tramway transportation of a target between two points insidethe abdomen.
  6. 6. MAGNETS
  7. 7. Tramway - Teleferico
  8. 8. A: InternalMagnetB: Alligator ClipApplierC: ExternalMagnet and theArticulated ArmSemin Pediatr Surg. 2011 Nov;20(4):224-31.The use of magnets with single-site umbilical laparoscopicsurgery.Padilla BE, Dominguez G, Millan C, Martinez-Ferro M.
  9. 9. Alligator clip applier opening the jaws
  10. 10. During a Transvaginal Cholecystectomy
  11. 11. During a Transvaginal Cholecystectomy
  12. 12. Transvaginal operation of a Large Liver Cyst
  13. 13. After de-roofing, the internal magnet transported the specimen to the pelvis in order tofacilitate the vaginal extraction. We see the roof of the liver cyst with the attachedmagnet
  14. 14. “Secured Independent Tools (SIT) is changing theLaparoscopy 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. 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, andmicromotors using the concept of secured independent tools.Tsin DA, Davila F, Dominguez G, Tinelli A, Davila MR.
  16. 16. Laboratory experience using a single incision port and anendoscopic bulldog clamp
  17. 17. Tramway in a simulator
  18. 18. A: Operative laparoscope with a 6 mm working channel . B: Curved roticulating grasperC: 12 mm port . D: 5 mm flexible port . Both ports are placed in the umbilicus
  19. 19. The first intravenous catheter is placed medially at a strategic point
  20. 20. This is the internal view of the needle and catheter
  21. 21. The Catheter is threaded with a 2-0 prolene suture
  22. 22. The second catheter is placed to allow the tramway to run between thetwo points of entrance
  23. 23. Both sutures were tied to the alligator
  24. 24. The alligator was placed at the base of the gallbladder using thealligator clip applier
  25. 25. Exposure achieved with the SIT tramway
  26. 26. Exposure continues during the procedure
  27. 27. The alligator is moved cephalic and medial
  28. 28. Two means of transportation, the magnet at the fundus and the SIT atthe base of the gallbladder
  29. 29. The magnet was released from the fundus and is now transporting anendoscopic bag
  30. 30. Here is another view of the magnet transporting the endoscopic bag
  31. 31. A companion video is available on YouTube:Laparoscopy Transportation Using Magnetsand Tramways –
  32. 32. Thank You for your Attention