Design, Development and Evaluation of an Inflatable Retractor for Atraumatic Retraction in Laparoscopic Colectomy

Abstract

Laparoscopic colectomy is the gold standard in the treatment of malignant tumours arising in the mucosa of the colon wall. The procedure is performed under general endotracheal anaesthesia and involves establishing a pneumoperitoneum with the patient in the Trendelenburg position. However this position can cause anaesthetic difficulties due to excess blood flow to the head and neck, increased pressure on the diaphragm and increased venous pressure. In the absence of steep head-down positioning, the bowels fall or "spill" into the operating field, obstructing the surgical space. The primary goal of this work is to design an atraumatic laparoscopic retractor to minimise the Trendelenburg position whilst effectively retracting the bowels from the operating field. This work details the design, evaluation and optimisation of a novel, hand held, inflatable, laparoscopic retractor, through physical experimentation, computer simulation, and pre-clinical animal investigation. The optimised design for the inflatable retractor performs in line with simulated expectations, and was successfully tested for safety and technical feasibility in vivo in a porcine model, where the bowels were effectively removed from the operating space whilst the model remained in the supine position. These initial results represent a promising approach for the mitigation of the Trendelenburg position, whilst effectively retracting the bowels during laparoscopic colectomy, using this atraumatic, inflatable retractor.

Balloon-Based Organ Retractor With Increased Safety and Reduced Invasiveness During Video-Assisted Thoracoscopic Surgery

“…There are some other commercially available surgical devices that use the same concept of enlarging the working contact surface area for endoscopic surgery 7,16 ; however, there is little literature outlining the benefits of such devices. A high frictional coefficient of the retractor surface is integral in providing effective and appropriate control of such slippery organs.…”

“…Although some differences in the concept of organ retraction exist, other studies reported balloon-based retractors for fixation of the bowel to minimize the Trendelenburg position during laparoscopic colectomy. 16 The retractor in this study mainly prioritized controllability, surface friction, and atraumaticity because of the characteristics of the lung and chest cavity, such as limitation of retractor motion, less friction of the lung surface, and sensitivity of the organ. In particular, in the retraction of the lung, the retraction force applied to the lung requires sensitivity to generate delicate tension for the pulmonary artery and vein.…”

An atraumatic retractor for interdisciplinary use in conventional laparoscopy and robotic surgery

“…In a preliminary analysis O'Shea et al tested an atraumatic inflatable laparoscopic retractor for retracting the bowel during colectomy [14].…”

Stability and Retraction Force Verification of a New Retractor Design for Minimally Invasive Surgery

“…MIS retractors are often unfoldable, like a fan or an umbrella. The efficiency of the retraction can be improved by optimizing the instrument used for retraction, an example of which is an inflatable atraumatic retractor or magnetic anchoring, however, these pose numerous engineering design and application challenges with respect to safe insertion, deployment and retraction [5]. The liver is a delicate tissue [6], often in the way of common MIS procedures, such as cholecystectomy [7].…”