Soft Tissue Dissector
Background: Laparoscopic surgery has become part of the standard armamentarium for many urologic surgeons. Currently a wide variety of instruments are used to facilitate dissection during laparoscopic surgery. Each time a different instrument is used, it requires removal and reinsertion. Over the course of a few hours, this can amount to a significant portion of time. One of the commonly used instruments is a cotton tipped dissector (i.e. Kitner) that is frequently used for blunt dissection. The tip provides a coarse surface that helps to "grab" the tissue and aids in developing surgical planes. Once the tip becomes saturated with fluid (e.g. blood, peritoneal fluid, or irrigation fluid) it looses its coarseness and becomes ineffective, necessitating replacement. Upwards of 10 to 20 of these instruments are routinely used in a single operative procedure. Kitners can also be used to dissect the vascular pedicle of the kidney. The renal artery lies posterior to the vein and is covered with connective and fatty tissue, sometimes making identification of the artery difficult.
In an effort to identify vessels, such as the renal artery or vein, Doppler ultrasound has been used. A Doppler probe can be placed onto the overlying tissue and identify a major vessel deep to these structures. Incorporating this technology into a laparoscopic instrument could make a significant contribution to renal surgery. The renal artery could be confidently identified before embarking on the often perilous dissection of the vascular pedicle. Technology: The new device we aim to develop incorporates both a new type of dissecting material on the working tip and Doppler ultrasound capability. It is improvement over current cottenoid material as it does not absorb moisture, thus maintaining its coarseness and the ability to dissect tissue over time; this change could potentially save time and costs in the operating room. The second feature is the Doppler ultrasound featured at the tip of the device. During surgery, without changing instruments, the Doppler ultrasound can be activated and the position of the renal artery, any accessory arteries, renal vein, and even segmental arteries could be confirmed before proceeding with the hilar dissection. Application: The concept of adding multiple functions to a single laparoscopic instrument is an important step in making laparoscopic surgery more efficient and potentially cost effective. This is a novel approach to laparoscopic instrument design and could eventually lead to one instrument with a multitude of functions. Some potential additional targets for this hollow probe, would be to add suction/irrigation, the Argon beam coagulator for hemostasis, and a holmium laser portal for cutting tissue. Ultimately, the goal would be to develop an instrument that can durably dissect tissue, prospectively identify renal vessels and then by flipping a switch on the output device, energy could be delivered to ablate a bleeding vessel. Indeed, with further developments in ultrasound technology, ultrasound energy could be used to both identify and then coagulate a given vessel in advance of its incision.
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