Investig Clin Urol.  2016 May;57(3):208-214. 10.4111/icu.2016.57.3.208.

Laparoendoscopic single-site simple nephrectomy using a magnetic anchoring system in a porcine model

• Choi YH
• Lee HW
• Lee SY
• Han DH
• Seo SI
• Jeon SS
• Lee HM
• Choi HY
• Jeong BC

• KMID: 2426496
• DOI: http://doi.org/10.4111/icu.2016.57.3.208

Abstract

PURPOSE
Magnetic anchoring devices may reduce the number of port sites needed in laparoscopic surgery. In this study, we prospectively assessed the feasibility of using a magnetic anchoring and guidance system (MAGS) in laparoendoscopic single-site (LESS) surgery performed by novices.
MATERIALS AND METHODS
A total of 10 LESS simple nephrectomies were performed with or without MAGS in a nonsurvival porcine model by 6 operators with no previous LESS surgery experience. After installation of the homemade single port, an intra-abdominal magnet was fixed to the renal parenchyma with suturing and stabilized by an external magnet placed on the flank so that the position of the kidney could be easily changed by moving the external handheld magnet. The length of the procedure and any intraoperative complications were evaluated.
RESULTS
Operative time (mean±standard deviation) was shorter in the group using the magnetic anchoring device (M-LESS-N) than in the group with conventional LESS nephrectomy (C-LESS-N) (63±20.8 minutes vs. 82±40.7 minutes, respectively). Although all nephrectomies were completed uneventfully in the M-LESS-N group, renal vein injury occurred during dissection of the renal hilum in two cases of C-LESS-N and was resolved by simultaneous transection of the renal artery and vein with an Endo-GIA stapler.
CONCLUSIONS
LESS-N using MAGS is a feasible technique for surgeons with no LESS surgery experience. Taking into account the 2 cases of renal vein injury in the C-LESS-N group, the application of MAGS may be beneficial for overcoming the learning curve of LESS surgery.

Keyword

Laparoscopy; Minimally invasive surgical procedures; Nephrectomy

MeSH Terms

Animals
Clinical Competence
Endoscopy/methods
Equipment Design
Feasibility Studies
Female
Intraoperative Period
Laparoscopy/adverse effects/*instrumentation/methods
*Magnetics
Minimally Invasive Surgical Procedures/adverse effects/instrumentation/methods
Models, Animal
Nephrectomy/adverse effects/*instrumentation/methods
Sus scrofa

Figure

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  Fig. 1 Homemade single port device.

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  Fig. 2 Magnetic anchoring and guidance system. (A) External handheld magnet. (B) Internal magnet with central hole.

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  Fig. 3 Laparoendoscopic single-site-simple nephrectomy with magnetic anchoring and guidance system (MAGS) platform. (A) Schematic representation of MAGS platform. (B) Internal magnet with central hole was fixed to kidney with suturing. (C) Kidney being retracted by the paired magnetic intraluminal device and external magnet. (D) The renal hilum is dissected with the aid of MAGS. Scan this QR code to see the accompanying video, or visit www.icurology.org or https://youtu.be/Pb46-HIlNuE.

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  Fig. 4 Comparison of times for LESS-simple nephrectomy depending on MAGS platform performed by same surgeon. LESS, laparoendoscopic single-site; MAGS, magnetic anchoring and guidance system; C-LESS-N, LESS nephrectomy without MAGS; M-LESS-N, LESS nephrectomy with MAGS.

Reference

1. Best SL, Cadeddu JA. Use of magnetic anchoring and guidance systems to facilitate single trocar laparoscopy. Curr Urol Rep. 2010; 11:29–32.

2. White WM, Haber GP, Goel RK, Crouzet S, Stein RJ, Kaouk JH. Single-port urological surgery: single-center experience with the first 100 cases. Urology. 2009; 74:801–804.

3. Desai MM, Berger AK, Brandina R, Aron M, Irwin BH, Canes D, et al. Laparoendoscopic single-site surgery: initial hundred patients. Urology. 2009; 74:805–812.

4. Stolzenburg JU, Kallidonis P, Hellawell G, Do M, Haefner T, Dietel A, et al. Technique of laparoscopic-endoscopic single-site surgery radical nephrectomy. Eur Urol. 2009; 56:644–650.

5. Raman JD, Bensalah K, Bagrodia A, Stern JM, Cadeddu JA. Laboratory and clinical development of single keyhole umbilical nephrectomy. Urology. 2007; 70:1039–1042.

6. Kurien A, Rajapurkar S, Sinha L, Mishra S, Ganpule A, Muthu V, et al. First prize: Standard laparoscopic donor nephrectomy versus laparoendoscopic single-site donor nephrectomy: a randomized comparative study. J Endourol. 2011; 25:365–370.

7. Park YH, Park JH, Jeong CW, Kim HH. Comparison of laparoendoscopic single-site radical nephrectomy with conventional laparoscopic radical nephrectomy for localized renal-cell carcinoma. J Endourol. 2010; 24:997–1003.

8. Tugcu V, Ilbey YO, Mutlu B, Tasci AI. Laparoendoscopic single-site surgery versus standard laparoscopic simple nephrectomy: a prospective randomized study. J Endourol. 2010; 24:1315–1320.

9. Cindolo L, Berardinelli F, Gidaro S, Schips L. Laparoendoscopic single-site partial nephrectomy without ischemia. J Endourol. 2010; 24:1997–2002.

10. Park S, Bergs RA, Eberhart R, Baker L, Fernandez R, Cadeddu JA. Trocar-less instrumentation for laparoscopy: magnetic positioning of intra-abdominal camera and retractor. Ann Surg. 2007; 245:379–384.

11. Zeltser IS, Bergs R, Fernandez R, Baker L, Eberhart R, Cadeddu JA. Single trocar laparoscopic nephrectomy using magnetic anchoring and guidance system in the porcine model. J Urol. 2007; 178:288–291.

12. Yin G, Han WK, Faddegon S, Tan YK, Liu ZW, Olweny EO, et al. Laparoendoscopic single site (LESS) in vivo suturing using a magnetic anchoring and guidance system (MAGS) camera in a porcine model: impact on ergonomics and workload. Urology. 2013; 81:80–84.

13. Clayman RV, Kavoussi LR, Soper NJ, Dierks SM, Meretyk S, Darcy MD, et al. Laparoscopic nephrectomy: initial case report. J Urol. 1991; 146:278–282.

14. Raybourn JH 3rd, Rane A, Sundaram CP. Laparoendoscopic single-site surgery for nephrectomy as a feasible alternative to traditional laparoscopy. Urology. 2010; 75:100–103.

15. Jeong BC, Park YH, Han DH, Kim HH. Laparoendoscopic single-site and conventional laparoscopic adrenalectomy: a matched case-control study. J Endourol. 2009; 23:1957–1960.

16. Tracy CR, Raman JD, Bagrodia A, Cadeddu JA. Perioperative outcomes in patients undergoing conventional laparoscopic versus laparoendoscopic single-site pyeloplasty. Urology. 2009; 74:1029–1034.

17. Best SL, Bergs R, Scott DJ, Fernandez R, Mashaud LB, Cadeddu JA. Solo surgeon laparo-endoscopic single site nephrectomy facilitated by new generation magnetically anchored and guided systems camera. J Endourol. 2012; 26:214–218.

18. Cadeddu J, Fernandez R, Desai M, Bergs R, Tracy C, Tang SJ, et al. Novel magnetically guided intra-abdominal camera to facilitate laparoendoscopic single-site surgery: initial human experience. Surg Endosc. 2009; 23:1894–1899.

19. Dominguez G, Durand L, De Rosa J, Danguise E, Arozamena C, Ferraina PA. Retraction and triangulation with neodymium magnetic forceps for single-port laparoscopic cholecystectomy. Surg Endosc. 2009; 23:1660–1666.

20. Cho YB, Park CM, Chun HK, Yi LJ, Park JH, Yun SH, et al. Transvaginal endoscopic cholecystectomy using a simple magnetic traction system. Minim Invasive Ther Allied Technol. 2011; 20:174–178.

21. Cho YB, Park JH, Chun HK, Park CM, Kim HC, Yun SH, et al. Multimedia article. Natural orifice transluminal endoscopic surgery applied to sigmoidectomy in survival animal models: using paired magnetic intra-luminal device. Surg Endosc. 2011; 25:1319–1324.