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851 A NEW PLATFORM IMPROVING ERGONOMY OF LAPAROSCOPIC SURGERY: EXPERIMENTAL STUDIES AND INITIAL CLINICAL EVALUATION
Vol. 187, No. 4S, Supplement, Monday, May 21, 2012
851 A NEW PLATFORM IMPROVING ERGONOMY OF LAPAROSCOPIC SURGERY: EXPERIMENTAL STUDIES AND INITIAL CLINICAL EVALUATION Jens Rassweiler*, Ali Serdar Goezen, Akbar Jalal, Jan Klein, Marcel Hruza, Michael Schulze, Heilbronn, Germany INTRODUCTION AND OBJECTIVES: Distribution of laparoscopic surgery is handicapped due to significant ergonomic limitations. We want to present experimental and clinical evaluation of a new operating chair used as a platform for laparoscopic surgery. METHODS: The surgical chair (ETHOS-platform) consists of a saddle-like seat, an adjustable chest-support, two individually adjustable armrests, and footrests. We compared suturing standing laterally to pelvi-trainer (“Torero-position”) versus standing behind pelvi-trainer and sitting on ETHOS. Every participant and surgeon (N⫽18) filled out a questionnaire focusing on ergonomic issues. Since August 2010, we performed 164 laparoscopic and retroperitoneoscopic procedures using ETHOS involving four different surgeons. Two frequent procedures (radical prostatectomy, pyeloplasty) underwent detailed comparison to matched-paired patients from our laparoscopic database. RESULTS: Ex-vivo, there was no significant different anastomotic time standing behind pelvi-trainer and sitting on ETHOS; the difference became significant compared to Torero-position mimicking clinical scenario (44.4 vs. 37.6 minutes). Independent from laparoscopic experience and workload complaints (total score) were significantly less with ETHOS-assistance (31.6 vs. 13.9). In-vivo comparison did not show different OR-times, but revealed statistically significant differences with respect to anastomotic times of ETHOS and DaVinci (23 vs. 19 vs. 19 minutes). CONCLUSIONS: Ergonomics of laparoscopy may be significantly improved by new platforms supporting the sitting position of the surgeon with armrests and integrated foot pedals.
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RESULTS: TR-and TV-NOTES-PN was successfully performed in all 8 pigs. Comparison of TR and TV approaches revealed no significant difference in mean: access time (33.5 vs. 30.8 min, p⫽0.626), operative time (212.5 vs. 197.5 min, p⫽0.561), estimated blood loss (68.8 vs. 66.3 mL, p⫽0.943), and volume of resected specimen (p⫽0.763). Necropsy did not demonstrate abdominal injuries. CONCLUSIONS: We demonstrate proof-of-principle for TR and TV-NOTES-PN in swine, with comparable perioperative parameters. Preclinical survival studies are requisite to assess potential of TR NOTES to be an alternative to TV.
Source of Funding: None
852 COMPARISON OF TRANSRECTAL AND TRANSVAGINAL HYBRID NATURAL ORIFICE TRANSLUMINAL ENDOSCOPIC SURGERY (NOTES) PARTIAL NEPHRECTOMY IN THE PORCINE MODEL Wassim M. Bazzi*, Sean P. Stroup, Takayuki Dotai, Seth A. Cohen, Ryan P. Kopp, Omer Raheem, James Masterson, Suzanne Gudeman, Caroline Colangelo, Santiago Horgan, Christopher J. Kane, Ithaar H. Derweesh, San Diego, CA INTRODUCTION AND OBJECTIVES: Transrectal Natural Orifice Transluminal Endoscopic Surgery (NOTES) nephrectomy has recently been performed in the porcine model. We compared feasibility of porcine Transrectal (TR) and Transvaginal (TV) hybrid NOTES partial nephrectomy (NOTES-PN). METHODS: 8 female pigs (45 kg) underwent TR (n⫽4) or TV (n⫽4) NOTES-PN. In both pneumoperitoneum was created by periumbilical 12-mm trocar, through which a laparoscope was advanced for intraabdominal visualization. For TV-NOTES-PN: A gastroscope (Olympus, Center Valley, PA) was used to obtain transvaginal peritoneal access. For TR-NOTES-PN: horizontal incision was made 2-cm above the dentate line and a submucosal tunnel was created in the posterior rectal wall. Gastroscope was advanced through the submucosal tunnel and retroperitoneum to the kidney. A peritoneal window was created. For both TR- and TV-NOTES-PN, the gastroscope was exchanged for the SPIDER System (TransEnterix, Morrisville, NC) TR, Figure 1). Flexible dissecting instruments and hook cautery introduced through the SPIDER arms were used to mobilize kidney (TR, Figure 2) and hilum. Periumbilical-introduced harmonic scalpel (Ethicon, Cincinnati, OH) and scissors were used to excise a portion of the lower pole. Lapra-Ty secured (Ethicon) sutured renorrhaphy was performed, followed by completion nephrectomy, TR or TV specimen extraction and rectotomy/vaginotomy closure.
Source of Funding: Stephen Weissman Kidney Cancer Research Fund
851 A NEW PLATFORM IMPROVING ERGONOMY OF LAPAROSCOPIC SURGERY: EXPERIMENTAL STUDIES AND INITIAL CLINICAL EVALUATION Jens Rassweiler*, Ali Serdar Goezen, Akbar Jalal, Jan Klein, Marcel Hruza, Michael Schulze, Heilbronn, Germany INTRODUCTION AND OBJECTIVES: Distribution of laparoscopic surgery is handicapped due to significant ergonomic limitations. We want to present experimental and clinical evaluation of a new operating chair used as a platform for laparoscopic surgery. METHODS: The surgical chair (ETHOS-platform) consists of a saddle-like seat, an adjustable chest-support, two individually adjustable armrests, and footrests. We compared suturing standing laterally to pelvi-trainer (“Torero-position”) versus standing behind pelvi-trainer and sitting on ETHOS. Every participant and surgeon (N⫽18) filled out a questionnaire focusing on ergonomic issues. Since August 2010, we performed 164 laparoscopic and retroperitoneoscopic procedures using ETHOS involving four different surgeons. Two frequent procedures (radical prostatectomy, pyeloplasty) underwent detailed comparison to matched-paired patients from our laparoscopic database. RESULTS: Ex-vivo, there was no significant different anastomotic time standing behind pelvi-trainer and sitting on ETHOS; the difference became significant compared to Torero-position mimicking clinical scenario (44.4 vs. 37.6 minutes). Independent from laparoscopic experience and workload complaints (total score) were significantly less with ETHOS-assistance (31.6 vs. 13.9). In-vivo comparison did not show different OR-times, but revealed statistically significant differences with respect to anastomotic times of ETHOS and DaVinci (23 vs. 19 vs. 19 minutes). CONCLUSIONS: Ergonomics of laparoscopy may be significantly improved by new platforms supporting the sitting position of the surgeon with armrests and integrated foot pedals.
THE JOURNAL OF UROLOGY姞
e347
RESULTS: TR-and TV-NOTES-PN was successfully performed in all 8 pigs. Comparison of TR and TV approaches revealed no significant difference in mean: access time (33.5 vs. 30.8 min, p⫽0.626), operative time (212.5 vs. 197.5 min, p⫽0.561), estimated blood loss (68.8 vs. 66.3 mL, p⫽0.943), and volume of resected specimen (p⫽0.763). Necropsy did not demonstrate abdominal injuries. CONCLUSIONS: We demonstrate proof-of-principle for TR and TV-NOTES-PN in swine, with comparable perioperative parameters. Preclinical survival studies are requisite to assess potential of TR NOTES to be an alternative to TV.
Source of Funding: None
852 COMPARISON OF TRANSRECTAL AND TRANSVAGINAL HYBRID NATURAL ORIFICE TRANSLUMINAL ENDOSCOPIC SURGERY (NOTES) PARTIAL NEPHRECTOMY IN THE PORCINE MODEL Wassim M. Bazzi*, Sean P. Stroup, Takayuki Dotai, Seth A. Cohen, Ryan P. Kopp, Omer Raheem, James Masterson, Suzanne Gudeman, Caroline Colangelo, Santiago Horgan, Christopher J. Kane, Ithaar H. Derweesh, San Diego, CA INTRODUCTION AND OBJECTIVES: Transrectal Natural Orifice Transluminal Endoscopic Surgery (NOTES) nephrectomy has recently been performed in the porcine model. We compared feasibility of porcine Transrectal (TR) and Transvaginal (TV) hybrid NOTES partial nephrectomy (NOTES-PN). METHODS: 8 female pigs (45 kg) underwent TR (n⫽4) or TV (n⫽4) NOTES-PN. In both pneumoperitoneum was created by periumbilical 12-mm trocar, through which a laparoscope was advanced for intraabdominal visualization. For TV-NOTES-PN: A gastroscope (Olympus, Center Valley, PA) was used to obtain transvaginal peritoneal access. For TR-NOTES-PN: horizontal incision was made 2-cm above the dentate line and a submucosal tunnel was created in the posterior rectal wall. Gastroscope was advanced through the submucosal tunnel and retroperitoneum to the kidney. A peritoneal window was created. For both TR- and TV-NOTES-PN, the gastroscope was exchanged for the SPIDER System (TransEnterix, Morrisville, NC) TR, Figure 1). Flexible dissecting instruments and hook cautery introduced through the SPIDER arms were used to mobilize kidney (TR, Figure 2) and hilum. Periumbilical-introduced harmonic scalpel (Ethicon, Cincinnati, OH) and scissors were used to excise a portion of the lower pole. Lapra-Ty secured (Ethicon) sutured renorrhaphy was performed, followed by completion nephrectomy, TR or TV specimen extraction and rectotomy/vaginotomy closure.
Source of Funding: Stephen Weissman Kidney Cancer Research Fund