Use of a new device for gasless endosurgery in a laparoscopic diaphragmatic hernia repair ex vivo canine model: A pre‐clinical study

Abstract

Objectives To test the feasibility of a new device for gasless laparoscopy in providing working space for diaphragmatic hernia repair in an ex vivo canine model as a pre‐clinical study. Study design Technical feasibility study. Animal Eight beagles and two greyhound cadavers (not client‐owned). Methods The new device was used for abdominal traction in gasless laparoscopic reconstruction of diaphragmatic hernias produced in dog cadavers. It consists of three main parts (vertical and horizontal rods, a three‐piece structure, and a 3D‐printed unit that incorporates slots for haemostatic forceps). Composite hernias (two incisions of about 4 cm) were closed by an intra‐corporeal suture [suture group (GS), n = 5] or by a central suture and a polypropylene mesh [mesh group (GM), n = 5]. Surgical steps were T1 (primary port access up to third port placement), T2 (defect development), and T3 (diaphragmatic reconstruction). Total surgical time (TT) was also recorded. Results The defect was successfully developed and reconstructed in all cadavers. To close the defect, 7.0 ± 0.7 crossed mattress sutures were required in the GS, and 15.2 ± 1.9 hernia staples and one intra‐corporal suture were used in the GM. T3 was longer (p = 0.0076) in GS (50.00 ± 16.46 min) than in GM (23.24 ± 5.25 min). TT was 87.22 ± 19.23 min in GS and 66.45 ± 6.38 min in GM (p = 0.0547). Conclusions Gasless laparoscopic diaphragmatic hernia repair using the developed device is feasible in the canine cadaver model. Both suture and mesh graft techniques for experimental diaphragmatic herniorrhaphy can be performed using this new device in this pre‐clinical model. Clinical significance This new device for gasless laparoscopy allows diaphragmatic herniorrhaphy by intra‐corporeal suture or mesh implantation in ex vivo canine model. The device demonstrates potential for future use in clinical cases.

Laparoscopic extra‐abdominal transfascial suturing technique for diaphragmatic rupture repair in a cat

“…In small dogs and cats, hernia repair may be challenging due to the small working space. For these reasons, a recent study described a new device used for abdominal traction in gasless laparoscopic reconstruction of diaphragmatic hernias in dog cadavers 21 . This new device for gasless laparoscopy (or lift laparoscopy) allows diaphragmatic herniorrhaphy by intracorporeal suture or mesh implantation and reduces pneumoperitoneum‐related changes 21 .…”

“…6 As reported in the literature, mattress sutures can be placed with an extracorporeal or intracorporeal approach using a standard needle holder or laparoscopic needle holder, respectively. 15,21 A large needle was selected by the authors for easier extra-abdominal application in this case. No intraoperative complications related to needle manipulation were recorded; however, careful needle manipulation under intra-abdominal visualization should be always performed to avoid thoracic or abdominal organ trauma.…”

“…21 Thus, due to potential complications related to carbon dioxide pneumoperitoneum, gasless surgery (or lift laparoscopy) is a promising alternative for diaphragmatic hernia repair in small animals. 8,20,21 Similarly, in the present case report, the first xiphoid suture, placed through an extra-abdominal transfascial technique, permitted lifting of the abdominal wall and diaphragm, improving the visualization and working space, and avoiding increases in insufflation pressure, thereby reducing the risk of excessive pneumoperitoneum-related changes.…”

Laparoscopic adrenalectomy: comparison between pneumoperitoneum and the use of a laparoscopic lift device in dog cadavers

“…This is an alternative that minimizes the complications resulting from the use of CO 2 . Different devices have been developed to elevate the abdominal wall (CHEN et al, 2017;BRUN et al, 2021). The most commonly used model in veterinary medicine is composed of a circular portion placed inside the abdomen and a rod suspended by a hook, thus elevating the abdominal wall GNANARAJ & RHODES, 2015).…”

“…This method has been criticized for providing less workspace than CO 2 pneumoperitoneum, potentially leading to longer operative times (FRANSSON & RAGLE, 2011;CHEN et al, 2017). A prototype of a multidirectional traction device was recently patented and has already been shown to be viable for laparoscopic diaphragmatic hernia repair in dog cadavers (BRUN et al, 2021).…”