SlideShare une entreprise Scribd logo
1  sur  32
Laparoscopy Transportation
Using Magnets and Tramways
           Daniel A. Tsin, MD (1),
        Guillermo Dominguez, MD (2),
            Fausto Davila, MD (3),
           Andrea Tinelli, MD (4),
          Martha R. Davila, MD (5),
        Marcelo Martinez Ferro, MD (2)
•The Mount Sinai Hospital of Queens; Long Island City, New
York, USA.

•Fundación Hospitalaria; Buenos Aires, Argentina.

•Universidad Autonoma de Mexico, Facultad de Estudios
Superiores; Iztacala, Mexico.

•Vito Fazzi Hospital, Department of Obstetrics & Gynecology,
Division of Experimental Endoscopic Surgery, Imaging,
Technology and Minimally Invasive Therapy; Lecce, Italy.

•Universidad Nacional Autonoma de Mexico (UNAM), GEA
Gonzalez Hospital, DF, México
Disclosure of Interest

Dr. Guillermo Dominguez founder of
IMANLAP reports that this financial
relationship had no influence on the
outcome or content of this paper.
 Other authors have no financial
interests to disclose.
Presented at the Annual Meeting and
Endo Expo of the Society of
Laparoendoscopic Surgeons.

SEPTEMBER 5–8, 2012, BOSTON,
MASSACHUSETTS, USA
Background:
This paper presents a means of intra-abdominal transportation without additional laparoscopy ports.

Methods:
We performed a single incision laparoscopy cholecystectomy using an operative laparoscope with an
operative channel. An alligator clip in tandem with a neodymium magnet was introduced in the
abdomen and placed on the target. A double tether alligator (Secured Independent Tool) was
introduced using two 18 gauge IV catheters strategically placed under laparoscopic surveillance. A
suture was threaded through the IV catheter and identified with the endoscope as it entered the
cavity. The suture was grasped and withdrawn until exiting via the operative port; this maneuver was
done twice. Outside the port, the sutures were tied to the Secured Independent Tool. The Secure
Independent Tool was introduced and placed on the target.

Results:
The magnet was used to hold the fundus of the gallbladder and transport the endobag. The Secured
Independent Tool was used for exposure, mobilization and transportation of the gallbladder. No
perforation of the gallbladder occurred and all functions were done successfully.

Conclusions:
Magnet transportation in the anterior peritoneum was unlimited in this case. The strategically placed
IV catheters allow for an aerial type of tramway transportation of a target between two points inside
the abdomen.
MAGNETS
Tramway - Teleferico
A: Internal
Magnet




B: Alligator Clip
Applier


C: External
Magnet and the
Articulated Arm



Semin Pediatr Surg. 2011 Nov;20(4):224-31.
The use of magnets with single-site umbilical laparoscopic
surgery.
Padilla BE, Dominguez G, Millan C, Martinez-Ferro M.
Alligator clip applier opening the jaws
During a Transvaginal Cholecystectomy
During a Transvaginal Cholecystectomy
Transvaginal operation of a Large Liver Cyst
After de-roofing, the internal magnet transported the specimen to the pelvis in order to
facilitate the vaginal extraction. We see the roof of the liver cyst with the attached
magnet
“Secured Independent Tools (SIT) is changing the
Laparoscopy paradigm. “
      Laparoscopy                       SIT

1 port per instrument.      Multiple instruments
                              per port.

Cannulas.                    Threads or Cables.


The diameter of the port    The diameter of the
 is larger that the           cable or thread is
 instrument.                  smaller that the
                              instrument.
The intravenous catheter is thread with a 2-0 prolene, which
               is grasped and withdrawn via a 12 mm port . The end is
               then tied to an alligator clip. To make a tramway, 2
               intravenous catheters must be placed at strategic points.




J Laparoendosc Adv Surg Tech A. 2012 May;22(4):397-9. Epub 2012 Mar 6.
Transabdominal wall deployment for instruments, lights, and
micromotors using the concept of secured independent tools.
Tsin DA, Davila F, Dominguez G, Tinelli A, Davila MR.
Laboratory experience using a single incision port and an
endoscopic bulldog clamp
Tramway in a simulator
A: Operative laparoscope with a 6 mm working channel . B: Curved roticulating grasper
C: 12 mm port . D: 5 mm flexible port . Both ports are placed in the umbilicus
The first intravenous catheter is placed medially at a strategic point
This is the internal view of the needle and catheter
The Catheter is threaded with a 2-0 prolene suture
The second catheter is placed to allow the tramway to run between the
two points of entrance
Both sutures were tied to the alligator
The alligator was placed at the base of the gallbladder using the
alligator clip applier
Exposure achieved with the SIT tramway
Exposure continues during the procedure
The alligator is moved cephalic and medial
Two means of transportation, the magnet at the fundus and the SIT at
the base of the gallbladder
The magnet was released from the fundus and is now transporting an
endoscopic bag
Here is another view of the magnet transporting the endoscopic bag
A companion video is available on YouTube:

Laparoscopy Transportation Using Magnets
and Tramways – YouTube

www.youtube.com/watch?v=AGxbtyJgcvE
Thank You for your Attention

Contenu connexe

Similaire à Laparoscopy Transportation using Magnets and Tramways

Vascular Access Devices
Vascular Access DevicesVascular Access Devices
Vascular Access Devicesmomdogz
 
Early experience with the da vinci® surgical
Early experience with the da vinci® surgicalEarly experience with the da vinci® surgical
Early experience with the da vinci® surgicalTariq Mohammed
 
Development Of A Rapid, Safe, Fiber Optic Guided, Single Incision Cricothyro...
Development Of A Rapid, Safe, Fiber Optic Guided,  Single Incision Cricothyro...Development Of A Rapid, Safe, Fiber Optic Guided,  Single Incision Cricothyro...
Development Of A Rapid, Safe, Fiber Optic Guided, Single Incision Cricothyro...James_DuCanto_MD
 
Preliminary results using coupler in microsurgery
Preliminary results using coupler in microsurgeryPreliminary results using coupler in microsurgery
Preliminary results using coupler in microsurgeryBinh Phuoc
 
Greath Saphenous Vein Cut-down as an access for the implantation of a Total I...
Greath Saphenous Vein Cut-down as an access for the implantation of a Total I...Greath Saphenous Vein Cut-down as an access for the implantation of a Total I...
Greath Saphenous Vein Cut-down as an access for the implantation of a Total I...eshaasini
 
Greath Saphenous Vein Cut-down as an access for the implantation of a Total I...
Greath Saphenous Vein Cut-down as an access for the implantation of a Total I...Greath Saphenous Vein Cut-down as an access for the implantation of a Total I...
Greath Saphenous Vein Cut-down as an access for the implantation of a Total I...eshaasini
 
Transcatheter mitral valve repair
Transcatheter mitral valve repairTranscatheter mitral valve repair
Transcatheter mitral valve repairRamachandra Barik
 
Prospective Evaluation of Intra operative Nucleus 22-channel cochlear implant...
Prospective Evaluation of Intra operative Nucleus 22-channel cochlear implant...Prospective Evaluation of Intra operative Nucleus 22-channel cochlear implant...
Prospective Evaluation of Intra operative Nucleus 22-channel cochlear implant...IJMER
 
Background and history of implanted ports
Background and history of implanted portsBackground and history of implanted ports
Background and history of implanted portshsparrow
 
Background and history of implanted ports
Background and history of implanted portsBackground and history of implanted ports
Background and history of implanted portshsparrow
 
Chest port implant access and techniques. Luc Rotenberg 2018
Chest port implant access and techniques. Luc Rotenberg 2018Chest port implant access and techniques. Luc Rotenberg 2018
Chest port implant access and techniques. Luc Rotenberg 2018Luc ROTENBERG
 
History of natural orifice transvaginal endoscopic surgery
History of natural orifice transvaginal endoscopic surgeryHistory of natural orifice transvaginal endoscopic surgery
History of natural orifice transvaginal endoscopic surgeryNew European Surgical Academy
 
THE PRACTICE OF EMERGENCY MEDICINEORIGINAL RESEARCH196 Ann.docx
THE PRACTICE OF EMERGENCY MEDICINEORIGINAL RESEARCH196 Ann.docxTHE PRACTICE OF EMERGENCY MEDICINEORIGINAL RESEARCH196 Ann.docx
THE PRACTICE OF EMERGENCY MEDICINEORIGINAL RESEARCH196 Ann.docxoreo10
 

Similaire à Laparoscopy Transportation using Magnets and Tramways (20)

J ENDOVASC THER 2010
J ENDOVASC THER 2010J ENDOVASC THER 2010
J ENDOVASC THER 2010
 
Vascular Access Devices
Vascular Access DevicesVascular Access Devices
Vascular Access Devices
 
自然腔道内镜手术
自然腔道内镜手术自然腔道内镜手术
自然腔道内镜手术
 
sialadenoscopy
sialadenoscopysialadenoscopy
sialadenoscopy
 
Early experience with the da vinci® surgical
Early experience with the da vinci® surgicalEarly experience with the da vinci® surgical
Early experience with the da vinci® surgical
 
Notes
Notes Notes
Notes
 
Nej mvcm074357
Nej mvcm074357Nej mvcm074357
Nej mvcm074357
 
Development Of A Rapid, Safe, Fiber Optic Guided, Single Incision Cricothyro...
Development Of A Rapid, Safe, Fiber Optic Guided,  Single Incision Cricothyro...Development Of A Rapid, Safe, Fiber Optic Guided,  Single Incision Cricothyro...
Development Of A Rapid, Safe, Fiber Optic Guided, Single Incision Cricothyro...
 
Tteh.000537
Tteh.000537Tteh.000537
Tteh.000537
 
Preliminary results using coupler in microsurgery
Preliminary results using coupler in microsurgeryPreliminary results using coupler in microsurgery
Preliminary results using coupler in microsurgery
 
Greath Saphenous Vein Cut-down as an access for the implantation of a Total I...
Greath Saphenous Vein Cut-down as an access for the implantation of a Total I...Greath Saphenous Vein Cut-down as an access for the implantation of a Total I...
Greath Saphenous Vein Cut-down as an access for the implantation of a Total I...
 
Greath Saphenous Vein Cut-down as an access for the implantation of a Total I...
Greath Saphenous Vein Cut-down as an access for the implantation of a Total I...Greath Saphenous Vein Cut-down as an access for the implantation of a Total I...
Greath Saphenous Vein Cut-down as an access for the implantation of a Total I...
 
Transcatheter mitral valve repair
Transcatheter mitral valve repairTranscatheter mitral valve repair
Transcatheter mitral valve repair
 
Prospective Evaluation of Intra operative Nucleus 22-channel cochlear implant...
Prospective Evaluation of Intra operative Nucleus 22-channel cochlear implant...Prospective Evaluation of Intra operative Nucleus 22-channel cochlear implant...
Prospective Evaluation of Intra operative Nucleus 22-channel cochlear implant...
 
Background and history of implanted ports
Background and history of implanted portsBackground and history of implanted ports
Background and history of implanted ports
 
Background and history of implanted ports
Background and history of implanted portsBackground and history of implanted ports
Background and history of implanted ports
 
Peritoneal dialysis catheter
Peritoneal dialysis catheterPeritoneal dialysis catheter
Peritoneal dialysis catheter
 
Chest port implant access and techniques. Luc Rotenberg 2018
Chest port implant access and techniques. Luc Rotenberg 2018Chest port implant access and techniques. Luc Rotenberg 2018
Chest port implant access and techniques. Luc Rotenberg 2018
 
History of natural orifice transvaginal endoscopic surgery
History of natural orifice transvaginal endoscopic surgeryHistory of natural orifice transvaginal endoscopic surgery
History of natural orifice transvaginal endoscopic surgery
 
THE PRACTICE OF EMERGENCY MEDICINEORIGINAL RESEARCH196 Ann.docx
THE PRACTICE OF EMERGENCY MEDICINEORIGINAL RESEARCH196 Ann.docxTHE PRACTICE OF EMERGENCY MEDICINEORIGINAL RESEARCH196 Ann.docx
THE PRACTICE OF EMERGENCY MEDICINEORIGINAL RESEARCH196 Ann.docx
 

Plus de New European Surgical Academy

How to search for natural orifice surgery in Chinese
How to search for natural orifice surgery in ChineseHow to search for natural orifice surgery in Chinese
How to search for natural orifice surgery in ChineseNew European Surgical Academy
 
History and the abdominal access via a natural orifice before Endoscopy
History and the abdominal access via a natural orifice before EndoscopyHistory and the abdominal access via a natural orifice before Endoscopy
History and the abdominal access via a natural orifice before EndoscopyNew European Surgical Academy
 
General_Surgery_News_Article_-_The_Birth_of_Natural_Orifice_Transluminal_Endo...
General_Surgery_News_Article_-_The_Birth_of_Natural_Orifice_Transluminal_Endo...General_Surgery_News_Article_-_The_Birth_of_Natural_Orifice_Transluminal_Endo...
General_Surgery_News_Article_-_The_Birth_of_Natural_Orifice_Transluminal_Endo...New European Surgical Academy
 
Culdolaparoscopy Cholecystectomy with Percutaneous Needle Assistance
Culdolaparoscopy Cholecystectomy with Percutaneous Needle AssistanceCuldolaparoscopy Cholecystectomy with Percutaneous Needle Assistance
Culdolaparoscopy Cholecystectomy with Percutaneous Needle AssistanceNew European Surgical Academy
 
Historia de la Cirugia Endoscopica Transvaginal por Orificios Naturales
Historia de la Cirugia Endoscopica Transvaginal por Orificios NaturalesHistoria de la Cirugia Endoscopica Transvaginal por Orificios Naturales
Historia de la Cirugia Endoscopica Transvaginal por Orificios NaturalesNew European Surgical Academy
 
Minilaparoscopy as an alternative to natural orifice surgery
Minilaparoscopy as an alternative to natural orifice surgeryMinilaparoscopy as an alternative to natural orifice surgery
Minilaparoscopy as an alternative to natural orifice surgeryNew European Surgical Academy
 

Plus de New European Surgical Academy (7)

How to search for natural orifice surgery in Chinese
How to search for natural orifice surgery in ChineseHow to search for natural orifice surgery in Chinese
How to search for natural orifice surgery in Chinese
 
History and the abdominal access via a natural orifice before Endoscopy
History and the abdominal access via a natural orifice before EndoscopyHistory and the abdominal access via a natural orifice before Endoscopy
History and the abdominal access via a natural orifice before Endoscopy
 
Culdoscopia la bella durmiente de la endoscopia
Culdoscopia la bella durmiente de la endoscopiaCuldoscopia la bella durmiente de la endoscopia
Culdoscopia la bella durmiente de la endoscopia
 
General_Surgery_News_Article_-_The_Birth_of_Natural_Orifice_Transluminal_Endo...
General_Surgery_News_Article_-_The_Birth_of_Natural_Orifice_Transluminal_Endo...General_Surgery_News_Article_-_The_Birth_of_Natural_Orifice_Transluminal_Endo...
General_Surgery_News_Article_-_The_Birth_of_Natural_Orifice_Transluminal_Endo...
 
Culdolaparoscopy Cholecystectomy with Percutaneous Needle Assistance
Culdolaparoscopy Cholecystectomy with Percutaneous Needle AssistanceCuldolaparoscopy Cholecystectomy with Percutaneous Needle Assistance
Culdolaparoscopy Cholecystectomy with Percutaneous Needle Assistance
 
Historia de la Cirugia Endoscopica Transvaginal por Orificios Naturales
Historia de la Cirugia Endoscopica Transvaginal por Orificios NaturalesHistoria de la Cirugia Endoscopica Transvaginal por Orificios Naturales
Historia de la Cirugia Endoscopica Transvaginal por Orificios Naturales
 
Minilaparoscopy as an alternative to natural orifice surgery
Minilaparoscopy as an alternative to natural orifice surgeryMinilaparoscopy as an alternative to natural orifice surgery
Minilaparoscopy as an alternative to natural orifice surgery
 

Dernier

Physiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid ArthritisPhysiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid ArthritisNilofarRasheed1
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets barmohitRahangdale
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxNaveenkumar267201
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptxWINCY THIRUMURUGAN
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfDolisha Warbi
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptPradnya Wadekar
 
introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)Mohamed Rizk Khodair
 
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...Ganesan Yogananthem
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfHongBiThi1
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismusChandrasekar Reddy
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)kishan singh tomar
 
General_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_WellbeingGeneral_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_WellbeingAnonymous
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisSujoy Dasgupta
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE Mamatha Lakka
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 
concept of total quality management (TQM).
concept of total quality management (TQM).concept of total quality management (TQM).
concept of total quality management (TQM).kishan singh tomar
 
The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?Ryan Addison
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.kishan singh tomar
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsMedicoseAcademics
 

Dernier (20)

Physiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid ArthritisPhysiotherapy Management of Rheumatoid Arthritis
Physiotherapy Management of Rheumatoid Arthritis
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets bar
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologyppt
 
introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)introduction to neurology (nervous system, areas, motor and sensory systems)
introduction to neurology (nervous system, areas, motor and sensory systems)
 
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
QUESTIONS & ANSWERS FOR QUALITY ASSURANCE, RADIATIONBIOLOGY& RADIATION HAZARD...
 
Cone beam CT: concepts and applications.pptx
Cone beam CT: concepts and applications.pptxCone beam CT: concepts and applications.pptx
Cone beam CT: concepts and applications.pptx
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismus
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)
 
General_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_WellbeingGeneral_Studies_Presentation_Health_and_Wellbeing
General_Studies_Presentation_Health_and_Wellbeing
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosis
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 
concept of total quality management (TQM).
concept of total quality management (TQM).concept of total quality management (TQM).
concept of total quality management (TQM).
 
The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?The Importance of Mental Health: Why is Mental Health Important?
The Importance of Mental Health: Why is Mental Health Important?
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functions
 

Laparoscopy Transportation using Magnets and Tramways

  • 1. Laparoscopy Transportation Using Magnets and Tramways Daniel A. Tsin, MD (1), Guillermo Dominguez, MD (2), Fausto Davila, MD (3), Andrea Tinelli, MD (4), Martha R. Davila, MD (5), Marcelo Martinez Ferro, MD (2)
  • 2. •The Mount Sinai Hospital of Queens; Long Island City, New York, USA. •Fundación Hospitalaria; Buenos Aires, Argentina. •Universidad Autonoma de Mexico, Facultad de Estudios Superiores; Iztacala, Mexico. •Vito Fazzi Hospital, Department of Obstetrics & Gynecology, Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy; Lecce, Italy. •Universidad Nacional Autonoma de Mexico (UNAM), GEA Gonzalez Hospital, DF, México
  • 3. Disclosure of Interest Dr. Guillermo Dominguez founder of IMANLAP reports that this financial relationship had no influence on the outcome or content of this paper. Other authors have no financial interests to disclose.
  • 4. Presented at the Annual Meeting and Endo Expo of the Society of Laparoendoscopic Surgeons. SEPTEMBER 5–8, 2012, BOSTON, MASSACHUSETTS, USA
  • 5. Background: This paper presents a means of intra-abdominal transportation without additional laparoscopy ports. Methods: We performed a single incision laparoscopy cholecystectomy using an operative laparoscope with an operative channel. An alligator clip in tandem with a neodymium magnet was introduced in the abdomen and placed on the target. A double tether alligator (Secured Independent Tool) was introduced using two 18 gauge IV catheters strategically placed under laparoscopic surveillance. A suture was threaded through the IV catheter and identified with the endoscope as it entered the cavity. The suture was grasped and withdrawn until exiting via the operative port; this maneuver was done twice. Outside the port, the sutures were tied to the Secured Independent Tool. The Secure Independent Tool was introduced and placed on the target. Results: The magnet was used to hold the fundus of the gallbladder and transport the endobag. The Secured Independent Tool was used for exposure, mobilization and transportation of the gallbladder. No perforation of the gallbladder occurred and all functions were done successfully. Conclusions: Magnet transportation in the anterior peritoneum was unlimited in this case. The strategically placed IV catheters allow for an aerial type of tramway transportation of a target between two points inside the abdomen.
  • 8. A: Internal Magnet B: Alligator Clip Applier C: External Magnet and the Articulated Arm Semin Pediatr Surg. 2011 Nov;20(4):224-31. The use of magnets with single-site umbilical laparoscopic surgery. Padilla BE, Dominguez G, Millan C, Martinez-Ferro M.
  • 9. Alligator clip applier opening the jaws
  • 10. During a Transvaginal Cholecystectomy
  • 11. During a Transvaginal Cholecystectomy
  • 12. Transvaginal operation of a Large Liver Cyst
  • 13. After de-roofing, the internal magnet transported the specimen to the pelvis in order to facilitate the vaginal extraction. We see the roof of the liver cyst with the attached magnet
  • 14. “Secured Independent Tools (SIT) is changing the Laparoscopy paradigm. “ Laparoscopy SIT 1 port per instrument. Multiple instruments per port. Cannulas.  Threads or Cables. The diameter of the port The diameter of the is larger that the cable or thread is instrument. smaller that the instrument.
  • 15. The intravenous catheter is thread with a 2-0 prolene, which is grasped and withdrawn via a 12 mm port . The end is then tied to an alligator clip. To make a tramway, 2 intravenous catheters must be placed at strategic points. J Laparoendosc Adv Surg Tech A. 2012 May;22(4):397-9. Epub 2012 Mar 6. Transabdominal wall deployment for instruments, lights, and micromotors using the concept of secured independent tools. Tsin DA, Davila F, Dominguez G, Tinelli A, Davila MR.
  • 16. Laboratory experience using a single incision port and an endoscopic bulldog clamp
  • 17. Tramway in a simulator
  • 18. A: Operative laparoscope with a 6 mm working channel . B: Curved roticulating grasper C: 12 mm port . D: 5 mm flexible port . Both ports are placed in the umbilicus
  • 19. The first intravenous catheter is placed medially at a strategic point
  • 20. This is the internal view of the needle and catheter
  • 21. The Catheter is threaded with a 2-0 prolene suture
  • 22. The second catheter is placed to allow the tramway to run between the two points of entrance
  • 23. Both sutures were tied to the alligator
  • 24. The alligator was placed at the base of the gallbladder using the alligator clip applier
  • 25. Exposure achieved with the SIT tramway
  • 26. Exposure continues during the procedure
  • 27. The alligator is moved cephalic and medial
  • 28. Two means of transportation, the magnet at the fundus and the SIT at the base of the gallbladder
  • 29. The magnet was released from the fundus and is now transporting an endoscopic bag
  • 30. Here is another view of the magnet transporting the endoscopic bag
  • 31. A companion video is available on YouTube: Laparoscopy Transportation Using Magnets and Tramways – YouTube www.youtube.com/watch?v=AGxbtyJgcvE
  • 32. Thank You for your Attention