Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Jan-Mar;18(1):41-5.
doi: 10.4293/108680813X13693422520161.

Feasibility of a combined percutaneous laparoscopic three-millimeter device

Sven Bringman  1 , Jan Dalenbäck  2 , Arthur Jänes  3
Affiliations

Feasibility of a combined percutaneous laparoscopic three-millimeter device

Sven Bringman et al. JSLS. 2014 Jan-Mar.

Abstract

Background and objectives: Needlescopic 3-mm instruments induce minimal trauma and produce excellent cosmetic results. A combination of a 3-mm abdominal wall incision and a 5-mm instrument in the abdominal cavity would combine the beneficial features of these two different sizes.

Methods: The Percutaneous Surgical System (PSS) (Ethicon EndoSurgery, Galway, Ireland) is a new instrument consisting of a 3-mm shaft that is introduced percutaneously into the abdominal cavity. Through a 5-mm trocar, a loader with a 5-mm attachment such as a Maryland dissector is introduced. The attachment is connected to the shaft, and the loader is removed from the abdomen. The feasibility of this device was evaluated retrospectively in 3 Swedish hospitals between January and September 2012.

Results: Twenty-eight patients were laparoscopically operated on (cholecystectomy, gastric bypass, fundoplication, incisional hernias, and totally extraperitoneal repair for inguinal hernia) by use of 1 or 2 PSSs in each operation (47 in total). It was feasible to use the PSS in all procedures except during the totally extraperitoneal repair procedure because of the limited available preperitoneal space. Especially in laparoscopic cholecystectomies, the two lateral 5-mm trocars were easily replaced by two 3-mm PSS instruments.

Conclusions: The use of the PSS is feasible in a number of laparoscopic procedures, where it can replace 5-mm trocars. Randomized controlled trials are needed to determine the future role of the PSS versus, for example, needlescopic laparoscopy.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
A 3-mm shaft with a sharp retractable tip is inserted directly through the abdominal wall through a small skin incision.
Figure 2.
Figure 2.
Close-up of Figure 1.
Figure 3.
Figure 3.
Three-millimeter instrument with sharp retractable tip.
Figure 4.
Figure 4.
Blunt tip and loader.
Figure 5.
Figure 5.
A 5-mm loader is inserted through a standard 5-mm trocar. It carries a 5-mm Maryland grasper attachment, which is either a Maryland dissector or a blunt grasper.
Figure 6.
Figure 6.
Close-up of Figure 5.
Figure 7.
Figure 7.
The Maryland dissector attachment is connected to the 3-mm shaft.
Figure 8.
Figure 8.
Close-up of Figure 7.
Figure 9.
Figure 9.
Connection between loader with Maryland grasper attachment and 3-mm shaft.
Figure 10.
Figure 10.
The loader is disconnected from the Maryland dissector attachment.
Figure 11.
Figure 11.
Close-up of Figure 10.
Figure 12.
Figure 12.
The loader is disconnected from the Maryland grasper attachment.
Figure 13.
Figure 13.
The loader is removed from the abdominal cavity, and the result is a 5-mm instrument attached on a 3-mm percutaneous shaft.
Figure 14.
Figure 14.
Close-up of Figure 13.
See this image and copyright information in PMC

References

    1. Sajid MS, Khan MA, Ray K, Cheek E, Baig MK. Needlescopic versus laparoscopic cholecystectomy: a meta-analysis. ANZ J Surg. 2009;79(6):437–442 - PubMed
    1. Mathias JM. Needlescopic surgery is painless and scarless. OR Manager. 1997;13(11):24, 26–27 - PubMed
    1. Cook WA. Needle laparoscopy in patients with suspected bowel adhesions. Obstet Gynecol. 1977;49(1):105–106 - PubMed
    1. Sajid MS, Khan MA, Cheek E, Baig MK. Needlescopic versus laparoscopic appendectomy: a systematic review. Can J Surg. 2009;52(2):129–134 - PMC - PubMed

LinkOut - more resources