Transabdominal Wall Deployment for Instruments,Lights,and Micromotors Using the Concept of Secured Independent Tools

Abstract

Abstract

Use of secured independent tools (SIT) is changing the laparoscopy paradigm, which involves the use of instruments inside the abdominal cavity that are operated via a port that is larger in diameter than the instrument itself. However, in SIT instead of ports we used filaments or cables. Here we describe a modified SIT for use in the introduction of sutures or cables inside the peritoneum. Cables or sutures are passed through a tunnel made by an intravenous catheter and then exteriorized via a 12-mm port for tying, plugging (attaching), or connecting to different types of devices such as an endoscopic bulldog, alligator clamps, lights, and micromotors. These devices are introduced inside the abdomen and remotely operated with cables or filaments. The use of SIT is not limited to laparoscopy; it was successfully used in clinical experiences of single-port and single-incision laparoscopy and could facilitate natural orifice surgery. The technique offers a good force for traction, retraction, and mobilization. In addition, it has transmission capabilities for cameras and may facilitate the placement of wired microrobotics.