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Providing more through less: current methods of retraction in SIMIS and NOTES cholecystectomy

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Abstract

Background

As the field of minimally invasive surgery continues to develop, surgeons are confronted with the challenge of performing conventional laparoscopic surgeries through fewer incisions while maintaining the same degree of safety and surgical efficiency. Most of these methods involve elimination of the ports previously designated for retraction. As a result, minimally invasive surgeons have been forced to develop minimally invasive and ingenious methods for providing adequate retraction for these procedures. Herein we present our experience using endoloops and internal retractors to provide retraction during Single Incision Minimally Invasive Surgery (SIMIS) and Natural Orifice Transluminal Endoscopic Surgery (NOTES) cholecystectomy. We also present a review of the alternative retraction methods currently being employed for these surgeries.

Methods

SIMIS was performed on 20 patients and NOTES was performed on 5 patients at our institution. Endoloops or internal retractors were used to provide retraction for all SIMIS procedures. Internal retractors provided retraction for all NOTES procedures.

Results

Successful cholecystectomy was accomplished in all cases. One SIMIS surgery required conversion to standard laparoscopy due to complex anatomy. There were no intraoperative complications. Although adequate retraction was accomplished in all cases, the internal retractors were found to provide superior and more versatile retraction compared to that of endoloops.

Conclusion

Adequate retraction greatly simplifies SIMIS and NOTES surgery. Endograb internal retractors were easy to use and were found to provide optimal retraction and exposure during these procedures without complications.

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Disclosure

Dr. Yoav Mintz is on the medical advisory board of Virtual Ports which is the company that manufactures Virtual Ports EndograbTM. Drs. Avraham Schlager, Abed Khalaileh, Noam Shussman, Ram Elazary, Andrei Keidar, Alon J. Pikarsky, Avi Ben-Shushan, Oren Shibolet, Santiago Horgan, Mark Talamini, Gideon Zamir, and Avraham I. Rivkind have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem, 91120, Israel

    Avraham Schlager, Abed Khalaileh, Noam Shussman, Ram Elazary, Andrei Keidar, Alon J. Pikarsky, Gideon Zamir, Avraham I. Rivkind & Yoav Mintz

  2. Department of Surgery, New York University Medical Center, New York, NY, 10016, USA

    Avraham Schlager

  3. Department of Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

    Avi Ben-Shushan

  4. Department of Gastroenterology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

    Oren Shibolet

  5. Department of Surgery, San Diego Medical Center, University of California, La Jolla, CA, 92123, USA

    Santiago Horgan & Mark Talamini

Authors
  1. Avraham Schlager
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  2. Abed Khalaileh
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  3. Noam Shussman
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  4. Ram Elazary
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  5. Andrei Keidar
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  6. Alon J. Pikarsky
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  7. Avi Ben-Shushan
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  8. Oren Shibolet
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  9. Santiago Horgan
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  10. Mark Talamini
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  11. Gideon Zamir
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  12. Avraham I. Rivkind
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  13. Yoav Mintz
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Corresponding author

Correspondence to Avraham Schlager.

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Schlager, A., Khalaileh, A., Shussman, N. et al. Providing more through less: current methods of retraction in SIMIS and NOTES cholecystectomy. Surg Endosc 24, 1542–1546 (2010). https://doi.org/10.1007/s00464-009-0807-6

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  • DOI: https://doi.org/10.1007/s00464-009-0807-6

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