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The Next Generation of Laparoscopic Instrumentation

Mon, 10/13/2008 - 11:21am

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Versaport Plus Bladeless Trocars from Covidien provide surgeons with enhanced security and control.
For nearly 25 years Laparoscopy has been changing the way surgery is being performed. As the minimally invasive approach continues to be extended to more and more procedures and specialties, hospitals have seen the valuable benefits of improved patient outcomes, shorter recovery times and faster OR turnaround times. Now, as advancing technologies and innovative techniques are being developed, laparoscopy is poised to move into a new generation of greater surgeon control and even less invasive procedures. Recent advances in laparoscopic instrumentation are now allowing surgeons to see more, access surgical sites more efficiently and even perform laparoscopy through a single port, as opposed to the multiple access ports currently required. Here we look at some of the newest laparoscopic instruments that are helping surgeons to move minimally invasive surgery to the next level.

Covidien (Mansfield, MA) is global provider of healthcare products that is dedicated to improving surgical efficiency and patient outcome through minimally invasive approaches to surgery. The company recently announced that they have received FDA 501(k) clearance for their new Covidien SILS™ procedure kit, which is indicated for Single-Incision Laparoscopic Surgery and other advanced laparoscopic procedures. The devices in the kit allow surgeons to perform laparoscopic procedures through a single skin incision in the umbilicus, drastically minimizing pain and scarring.

Committed to improving surgeon access and reducing patient trauma in laparoscopic procedures, Covidien also offers a line of bladeless trocars. The VersaStep™ Plus 15mm is a bladeless laparoscopic access system with a radially expandable sleeve that minimizes the fascial defect and reduces the downward insertion forces associated with normal trocar insertion. The VersaStep Plus 15mm is an addition to the existing VersaStep Plus line and offers all of the benefits of Covidien’s proprietary STEP™ technology.

Encision, Inc. recently launched the next generation of EnTouch handles for its AEM articulating laparoscopic instrument inserts.
Also available are the new Covidien Versaport™ Plus Bladeless Trocars, a complete product line offering secure entry technology for enhanced security and control. Versaport Plus Bladeless offers surgeons low insertion force, small fascial defect and superior fixation; important features surgeons consistently ask for in bladeless technology.

Novare Surgical Systems (Cupertino, CA) has developed and markets the innovative line of RealHand® High Dexterity (HD) Instruments for minimally invasive surgery. The RealHand HD instruments a family of full range of motion handheld laparoscopic instruments. RealHand technology is designed to mirror the surgeon's hand direction with the added benefit of tactile feedback. As such, when the surgeon's hand moves in one direction, the instrument tip follows exactly.

Unlike standard laparoscopic instrumentation, RealHand offers seven degrees of freedom of movement with no need for additional hardware. This will enable surgeons to perform more difficult maneuvers that otherwise cannot be completed with traditional rigid instruments. RealHand HD instruments make it easy to actively manipulate and complete tasks regardless of whether the instrument is positioned over, under, or around structures.

Megadyne's Resposable E-Z Clean Laparoscopic Electrodes are available in a variety of tip configurations.
In addition, Novare Surgical Systems recently announced the successful completion of a series of single port Lap-Band® procedures that results in reduced scarring and less postoperative pain for patients. Dr. Julio Teixeira at St. Luke's-Roosevelt Hospital has pioneered an innovative approach that allows for the entire Lap-Band procedure to be performed exclusively through the patient's belly button. Dr. Teixeira uses RealHand HD instruments to enable the procedure and his approach eliminates an upper abdominal trocar placement that is often a site for significant patient discomfort.

Olympus (Center Valley, PA), a global leader in minimally invasive surgical technology, continues to develop innovative solutions for surgical endoscopy with the introduction of the LTF-VH Deflectable Tip Laparoscope, the world’s first deflectable HD video laparoscope. This video laparoscope upgrades the distally mounted video chip to HD and combines it with an advanced flexible tip design, which provides a complete 100 degree field of view from multiple angles to visually capture the desired location head-on, from above or even from behind. The advanced flexible tip also eliminates the need to change between 0 and 30 degree scopes intraoperatively. Incorporation of this deflectable tip on the telescope provides surgeons with a larger field of view, helps them avoid situations where the tips of the instruments collide and delivers the maneuverability and access that are required for single port laparoscopy.

Another company that has been at the forefront of developing a full range of products and programs to bring the benefits of single port laparoscopy to the mainstream is Cambridge Endo (Framingham, MA). The company’s Autonomy™ Laparo-Angle™ Instruments are a full line of articulating handheld instruments for pure laparoscopy. These unique, articulating instruments offer seven degrees of freedom for access to difficult areas and for tip positioning and control. The instruments map the motion of the surgeon’s hand, enabling simultaneous actions such as articulating downward while rotating the distal tip. The tip can be positioned in the optimal orientation for fully-controlled suturing, cutting, dissecting and cauterizing. The Autonomy Laparo-Angle line includes a needle holder, electrocautery-capable Metzenbaum scissors, Maryland dissector and electrosurgery hook. All instruments are 5 mm and can be used in standard trocars.

The LTF-VH Deflectable Tip Laparoscope from Olympus provides a complete 100 degree field of view from multiple angles.
Aesculap, Inc. (Center Valley, PA) offers a full line of instruments for minimally invasive surgery that can help improve surgeon control and overall efficiency throughout laparoscopic procedures. The Aesculap laparoscopic axial needle holders offer superior needle control and secure suture grasping for suturing of both fine and coarse tissues. The unique ergonomic handle allows the instruments to be turned with extreme ease at the wrist. The shape and geometry of the jaw makes it easy to grasp tissues in any position supporting the two needle holder approach and facilitating suturing in a coordinated and efficient manner. A variety of jaw options also helps to simplify suturing in all laparoscopic indications.

Also available are the Aesculap Laparoscopic Reposable Scissors, a cost effective way to ensure surgeons have a new sharp cut during every laparoscopic procedure. The reposable system is comprised of a disposable sterile scissors shaft and a reusable handle. The disposable shaft provides laparoscopic surgeons with a new sharp scissors jaw and insulation for every case. A selection of reusable handles is also available, providing the surgeon the ability to customize the instrument to his or her perference. Aesculap’s Laparoscopic Reposable scissors are offered in four different patterns; Hook, Mini-Metz, Metzenbaum and bariatric Metzenbaum.

Aesculap also offers the innovative PL541S Intestinal Bulldog Clip, which is designed for applications where temporary occlusion of the bowel is desired. It is typically used in laparoscopic gastric bypass procedures during the assessment of the gastrojejunostomy for leaks. At this step of the procedure, the Roux limb can be occluded with the intestinal bulldog clip to prevent excessive bowel and distal gastric dilation. The Intestinal Bulldog Clip offers several advantages over a handheld laparoscopic clamp. The bulldog application forceps can be removed from the port site after the bulldog is applied; thus freeing up the port site for introduction of other laparoscopic instrumentation as needed.

The Autonomy Laparo-Angle Instruments from Cambridge Endo are a full line of articulating handheld instruments.
Megadyne (Draper, UT), a supplier of quality electrosurgical equipment, has applied their innovative design and technology to laparoscopic surgery, now offering Resposable E-Z Clean® Laparoscopic Electrodes with Safety Indicator Shafts. These laparoscopic electrodes feature E-Z Clean MegaTIPs to provide excellent dissection and coagulation for a variety of laparoscopic applications, rendering surgical procedures cleaner, faster and safer. Disposable MegaTIPs come in a variety of configurations including Curved Blade, L-Hook, J-Hook, L-Wire and Modified versions, all of which easily attach to the reusable indicator shaft. The indicator shaft’s two-layer, color-coded insulation alert protects against stray electrical current, helping to avoid coupling and burns. Megadyne also offers 45-cm Bariatric-Length Disposable Laparoscopic Electrodes for gastric bypass, gastric banding and any procedures where extra length is indicated.

Earlier this year, Encision, Inc. (Boulder, CO) announced the launch of its next generation of EnTouch handles for its AEM® articulating laparoscopic instrument inserts. The new ES8200 and ES8200L handles feature a stiffer shaft design to accommodate the stresses generated by organ manipulation during advanced as well as routine laparoscopic procedures. In addition, the new, easy to operate rotation knob design allows a surgeon to lock the electrode tip in the preferred orientation for the particular need during a laparoscopic procedure. The EnTouch model ES8200 is 35cm in length for normal size patients while the ES8200L is 45 cm in length for large patients and many bariatric procedures.

In addition, Encision recently launched its new disposable hand-activated fixed-tip electrode line of laparoscopic instruments. The new disposable fixed-tip electrode line features hand activation for surgeons who prefer to energize the electrode via a fingertip switch rather than pressing their foot on a foot pedal.

These are just a few of the unique and innovative new laparoscopic instruments that are helping laparoscopy to continue to advance into the next generation of safe and effective patient care.
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