A Novel Set Of Surgical Instruments Facilitate The Procedure Of Laparoscopic Pyeloplasty

Objective As the rapid development of minimally invasive technology in urologyduring recent20years, equipment innovations have played a promoting role in urologicalsurgical prosedures. Laparoscopic pyeloplasty is not widely prevelant because of thetechnically challenging nature and relatively steeo learning curve. To overcome somedifficulties and technical challenges encountered during pure laparoscopic pyeloplasty, wedesigned a set of new instruments and assessed them using porcine model.Methods According to the time consuming steps of laparoscopic pyeloplasty such asspatulating the ureter, placement of the first stitch on the ureter, exposure and closure ofthe closure of the posterior ureteral wall, our surgeon and medical engineer designed threenew instruments, including the right angle laparoscopy scissors, the petal-shape ureterdilator and the guide tube. Four experienced laparoscopic experts were involved in a nosurvival porcine study to assess the help of these new instruments. Four experiments wereconducted on live pigs at the same time. After general anesthesia was administered,transperitoneal ureteroureterostomy was performed using standard laparoscopicinstruments, including placing the double J stent anterograde. Then, the opposite lateralwas done by the same surgeon plus these new devices for side-by-side comparativeanalysis. All experts were interviewed to assess these new instruments by the questionnaire.The questionnaire contained the following two items with responses as visual analog scale(VAS) ratings, from1(not at all) to10(very much).(1) Do you think that this newinstrument can help for your procedure (Help Score)?(2) Does this new instrument bringnew difficulties to you (New Difficulty Score)? A comment content was also added, whichcould be helpful for the surgeons to express their opinion more comprehensively. Rightangle laparoscopy scissors and the guide tube were used in clinical cases. Recording andanalysing the time of spatulating the ureter and introducing the double J stent which wasdone by new instruments and the traditional laparoscopic instruments respectively.Results The surgeries were all successful without complications or converting to opensurgery. The procedures were all technically successful. The right angle laparoscopyscissors and the guide tube were accepted by all participants and the Help Score were6.75and4.25respectively, at the same time the New Difficulty Score1.25and1.75. However,the petal-shape ureter dilator got1.5Help Score and6.5New Difficulty Score. These surgeons made a negative comment and one of surgeons recommended the stone basketwas more suitable. The mean time of spatulating the ureter which were done by traditionalinstruments and new instruments were98.6s and38.5s respectively. The mean time ofintroducing double J stent which were done by traditional instruments and new instrumentswere9.3min and4.2min respectively.Conclusions By means of the right angle laparoscopy scissors and the guide tubewhich we designed, we can shorten the learning curve and improve the success rates of thesurgery. Equipments innovations can promote laparoscopic skills to use in the LP.