14-Gauge Angiocatheter: The Assist Port

Abstract

Abstract

Introduction:

Minimally invasive techniques have emerged as the standard of care for some procedures in pediatric urology. In an effort to minimize required ports for robotic-assisted laparoscopic (RAL) surgeries in children, we describe in this article a novel technique for using a 14-gauge (G) angiocatheter as an assist port in concert with various readily available cystoscopic equipment.

Materials and Methods:

After the insertion of robotic ports and docking, the da Vinci^® Surgical System (Intuitive Surgical, Sunnyvale, CA), using a 14-G angiocatheter, was placed through the abdominal wall under direct vision. The 14-G angiocatheter was then used to facilitate stent placement, provide a port for semiflexible cystoscopic graspers, and to evacuate cautery smoke. At the end of each case, the 14-G angiocatheter was removed under direct vision prior to undocking the robot.

Results:

A 14-G angiocatheter was used as an assist port in 17 RAL urologic procedures (16 RAL dismembered pyeloplasties and 1 robotic orchiopexy). No complications occurred and the angiocatheter's use avoided the placement of 3- or 5-mm additional assist ports.

Conclusions:

The 14-G angiocath technique uses existing equipment, requires no closure, and can be placed anywhere on the abdominal wall. It allows the RAL dismembered pyeloplasty to be performed with only two instrument ports and no additional trocar for assistance. This is the first described method in the urologic literature of using a 14-G angiocatheter to maximize operative assistance while minimizing port placement in pediatric RAL surgery.