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Magnetically anchored camera and percutaneous instruments maintain triangulation and improve cosmesis compared with single-site and conventional laparoscopic cholecystectomy

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Abstract

Background

This study evaluated operative outcomes and ergonomics for a magnetic camera (MAGS) used in conjunction with percutaneous instruments [percutaneous surgical set (PSS)] compared with single-site laparoscopic (SSL) and conventional laparoscopic (LAP) cholecystectomy techniques.

Methods

Four surgical trainees each performed three porcine cholecystectomies using three randomized techniques including MAGS/PSS, SSL, and LAP. The operative outcomes, procedure-specific ratings (1–5 scale; 1 = superior), workload (1–10 scale; 1 = superior), and global impressions (1–10 scale; 10 = superior) were recorded. Comparisons used analysis of variance (ANOVA) on ranks (Kruskal-Wallis), and p values lower than 0.05 were considered significant.

Results

The operative outcomes were similar except for significantly higher blood loss with SSL (16.3 ± 10.3) versus LAP (2.8 ± 1.5; p < 0.05) but not with MAGS/PSS (4.8 ± 3.8). Several inadvertent tissue-damaging events occurred with SSL but not with MAGS/PSS or LAP. The incision was significantly shorter with MAGS/PSS (29.3 ± 2.8 mm) and SSL (29.3 ± 2.5 mm) than with LAP (48.0 ± 3.6 mm; p < 0.05). Compared with SSL (3.6 ± 0.5), the procedure-specific ratings significantly favored MAGS/PSS (2.8 ± 0.4) and LAP (1.7 ± 0.2; p < 0.05). Ergonomics and technical challenges both were rated significantly inferior with SSL (4.3 ± 1.0 and 3.8 ± 0.5, respectively) versus LAP (1.5 ± 0.6 and 2.0 ± 0.8, respectively; p < 0.05) but not with MAGS/PSS (2.5 ± 1.0 and 3.0 ± 0.8, respectively). Both MAGS/PSS (4.5 ± 0.5) and SSL (4.8 ± 1.0) were associated with a significantly greater workload than LAP (2.5 ± 0.6; p < 0.05). Global impression ratings were significantly higher for LAP (8.7 ± 1.3) versus SSL (5.8 ± 2.0; p < 0.05) but not for MAGS/PSS (7.1 ± 1.8). Cosmesis was significantly better with MAGS/PSS (9.5 ± 0.6) versus LAP (6.5 ± 2.4; p < 0.05) but not with SSL (8.8 ± 1.3).

Conclusion

The MAGS/PSS technique allows better triangulation and fewer technical difficulties than SSL and better cosmesis than LAP. Further development of these devices is warranted.

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Disclaimer

The devices described in this article are not approved by the Food and Drug Administration (FDA) for human use and are intended for research purposes only at this time. 

Disclosures

Jeffrey A. Cadeddu, Richard Bergs, Raul Fernandez, and Daniel J. Scott have received research grants from Ethicon Endo-Surgery, Inc. and hold a licensing agreement on the use of Ethicon’s Magnetic Anchoring and Guidance System (MAGS). Daniel J. Scott also has received research grants from Covidien as well as research and equipment grants from Karl Storz Endoscopy. In addition, he acts as a consultant for Accelerated Technologies, Inc. and NeatStitch, Inc. Nabeel A. Arain, Luisangel Rondon, and Deborah C. Hogg have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, The University of Texas Southwestern Medical Center, Southwestern Center for Minimally Invasive Surgery, 5323 Harry Hines Boulevard, Dallas, TX, 75390-9156, USA

    Nabeel A. Arain, Luisangel Rondon, Deborah C. Hogg & Daniel J. Scott

  2. Department of Urology, The University of Texas Southwestern Medical Center, Southwestern Center for Minimally Invasive Surgery, Dallas, TX, USA

    Jeffrey A. Cadeddu

  3. TMAC, Automation and Robotics Research Institute, The University of Texas at Arlington, Arlington, TX, USA

    Richard Bergs & Raul Fernandez

Authors
  1. Nabeel A. Arain
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  2. Luisangel Rondon
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  3. Deborah C. Hogg
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  4. Jeffrey A. Cadeddu
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  5. Richard Bergs
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  6. Raul Fernandez
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  7. Daniel J. Scott
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Correspondence to Nabeel A. Arain.

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Arain, N.A., Rondon, L., Hogg, D.C. et al. Magnetically anchored camera and percutaneous instruments maintain triangulation and improve cosmesis compared with single-site and conventional laparoscopic cholecystectomy. Surg Endosc 26, 3457–3466 (2012). https://doi.org/10.1007/s00464-012-2354-9

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  • DOI: https://doi.org/10.1007/s00464-012-2354-9

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