Instrumentation for laparoscopic renal surgery-Padron Endoscopic Exposing Retractor (PEER) and Endoholder: Point of technique

Jamil Rehman, Chandru Sundaram, Sardar A. Khan, Ramakrishna Venkatesh, Wayne C. Waltzer

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

During laparoscopic surgery, as in open surgery, exposure is critical. However, this can be difficult during laparoscopy due to limited haptic feedback and the loss of 3-dimensional visualization. Excessive force may be inadvertently applied by assistants when anatomic structures are retracted; similarly, the retractors may be unknowingly moved because the limited field of view with the laparoscope precludes constant visualization of the retracting instrument. To overcome these problems, we have been using a 5- or 10-mm PEER retractor in combination with an articulating arm instrument holder (Endoholder) to aid laparoscopic renal surgery. The adjustable spring-loaded articulating instrument holder (Endoholder) consists of 4 components, including table attachment, a base rod, flexible extension arm, and precision clamp. The clamp accommodates variously sized instruments, and the flexible extension arm rotates 360 degrees to aid in positioning. The instrument holder is clamped to the table via the base rod over a sterile drape. A PEER Retractor, Roto-Iok ratchet (5- or 10-mm diameter and 32-cm length) is placed intracorporeally to retract and position the kidney for hilar, upper, and lower pole dissection. The PEER retractor's handle is secured in place using the precision clamp of the instrument holder. The articulating instrument holder and PEER retractor are used for our renal, adrenal, and ureteral laparoscopic procedures. Placement of the retractor through a 5- or 10-mm port and deployment can be done quickly. Adequate and stable positioning of the retractor provides excellent and secure visualization of the operative field. These instruments have been used in more than 200 cases without any complication except 1 minor liver laceration. The articulating instrument holder with the PEER retractor is a very useful aid during laparoscopic renal surgery. This instrument reduces the chances of inadvertent injury to viscera by the assistant while maintaining an excellent anatomic view throughout the procedure. This will have a significant impact on the advancement of laparoscopy and its acceptance by every urologist.

Original languageEnglish
Pages (from-to)18-21
Number of pages4
JournalSurgical Laparoscopy, Endoscopy and Percutaneous Techniques
Volume15
Issue number1
StatePublished - Feb 2005

Fingerprint

Laparoscopy
Kidney
Arm
Laparoscopes
Viscera
Lacerations
Dissection
Liver
Wounds and Injuries

Keywords

  • Adrenalectomy
  • Kidney
  • Laparoscopy
  • Nephrectomy
  • PEER retractor
  • Retraction
  • Ureteral surgery Endoholder

ASJC Scopus subject areas

  • Surgery

Cite this

Instrumentation for laparoscopic renal surgery-Padron Endoscopic Exposing Retractor (PEER) and Endoholder : Point of technique. / Rehman, Jamil; Sundaram, Chandru; Khan, Sardar A.; Venkatesh, Ramakrishna; Waltzer, Wayne C.

In: Surgical Laparoscopy, Endoscopy and Percutaneous Techniques, Vol. 15, No. 1, 02.2005, p. 18-21.

Research output: Contribution to journalArticle

@article{3ba586a045de457ea818b9e2e45f6c28,
title = "Instrumentation for laparoscopic renal surgery-Padron Endoscopic Exposing Retractor (PEER) and Endoholder: Point of technique",
abstract = "During laparoscopic surgery, as in open surgery, exposure is critical. However, this can be difficult during laparoscopy due to limited haptic feedback and the loss of 3-dimensional visualization. Excessive force may be inadvertently applied by assistants when anatomic structures are retracted; similarly, the retractors may be unknowingly moved because the limited field of view with the laparoscope precludes constant visualization of the retracting instrument. To overcome these problems, we have been using a 5- or 10-mm PEER retractor in combination with an articulating arm instrument holder (Endoholder) to aid laparoscopic renal surgery. The adjustable spring-loaded articulating instrument holder (Endoholder) consists of 4 components, including table attachment, a base rod, flexible extension arm, and precision clamp. The clamp accommodates variously sized instruments, and the flexible extension arm rotates 360 degrees to aid in positioning. The instrument holder is clamped to the table via the base rod over a sterile drape. A PEER Retractor, Roto-Iok ratchet (5- or 10-mm diameter and 32-cm length) is placed intracorporeally to retract and position the kidney for hilar, upper, and lower pole dissection. The PEER retractor's handle is secured in place using the precision clamp of the instrument holder. The articulating instrument holder and PEER retractor are used for our renal, adrenal, and ureteral laparoscopic procedures. Placement of the retractor through a 5- or 10-mm port and deployment can be done quickly. Adequate and stable positioning of the retractor provides excellent and secure visualization of the operative field. These instruments have been used in more than 200 cases without any complication except 1 minor liver laceration. The articulating instrument holder with the PEER retractor is a very useful aid during laparoscopic renal surgery. This instrument reduces the chances of inadvertent injury to viscera by the assistant while maintaining an excellent anatomic view throughout the procedure. This will have a significant impact on the advancement of laparoscopy and its acceptance by every urologist.",
keywords = "Adrenalectomy, Kidney, Laparoscopy, Nephrectomy, PEER retractor, Retraction, Ureteral surgery Endoholder",
author = "Jamil Rehman and Chandru Sundaram and Khan, {Sardar A.} and Ramakrishna Venkatesh and Waltzer, {Wayne C.}",
year = "2005",
month = "2",
language = "English",
volume = "15",
pages = "18--21",
journal = "Surgical Laparoscopy, Endoscopy and Percutaneous Techniques",
issn = "1530-4515",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Instrumentation for laparoscopic renal surgery-Padron Endoscopic Exposing Retractor (PEER) and Endoholder

T2 - Point of technique

AU - Rehman, Jamil

AU - Sundaram, Chandru

AU - Khan, Sardar A.

AU - Venkatesh, Ramakrishna

AU - Waltzer, Wayne C.

PY - 2005/2

Y1 - 2005/2

N2 - During laparoscopic surgery, as in open surgery, exposure is critical. However, this can be difficult during laparoscopy due to limited haptic feedback and the loss of 3-dimensional visualization. Excessive force may be inadvertently applied by assistants when anatomic structures are retracted; similarly, the retractors may be unknowingly moved because the limited field of view with the laparoscope precludes constant visualization of the retracting instrument. To overcome these problems, we have been using a 5- or 10-mm PEER retractor in combination with an articulating arm instrument holder (Endoholder) to aid laparoscopic renal surgery. The adjustable spring-loaded articulating instrument holder (Endoholder) consists of 4 components, including table attachment, a base rod, flexible extension arm, and precision clamp. The clamp accommodates variously sized instruments, and the flexible extension arm rotates 360 degrees to aid in positioning. The instrument holder is clamped to the table via the base rod over a sterile drape. A PEER Retractor, Roto-Iok ratchet (5- or 10-mm diameter and 32-cm length) is placed intracorporeally to retract and position the kidney for hilar, upper, and lower pole dissection. The PEER retractor's handle is secured in place using the precision clamp of the instrument holder. The articulating instrument holder and PEER retractor are used for our renal, adrenal, and ureteral laparoscopic procedures. Placement of the retractor through a 5- or 10-mm port and deployment can be done quickly. Adequate and stable positioning of the retractor provides excellent and secure visualization of the operative field. These instruments have been used in more than 200 cases without any complication except 1 minor liver laceration. The articulating instrument holder with the PEER retractor is a very useful aid during laparoscopic renal surgery. This instrument reduces the chances of inadvertent injury to viscera by the assistant while maintaining an excellent anatomic view throughout the procedure. This will have a significant impact on the advancement of laparoscopy and its acceptance by every urologist.

AB - During laparoscopic surgery, as in open surgery, exposure is critical. However, this can be difficult during laparoscopy due to limited haptic feedback and the loss of 3-dimensional visualization. Excessive force may be inadvertently applied by assistants when anatomic structures are retracted; similarly, the retractors may be unknowingly moved because the limited field of view with the laparoscope precludes constant visualization of the retracting instrument. To overcome these problems, we have been using a 5- or 10-mm PEER retractor in combination with an articulating arm instrument holder (Endoholder) to aid laparoscopic renal surgery. The adjustable spring-loaded articulating instrument holder (Endoholder) consists of 4 components, including table attachment, a base rod, flexible extension arm, and precision clamp. The clamp accommodates variously sized instruments, and the flexible extension arm rotates 360 degrees to aid in positioning. The instrument holder is clamped to the table via the base rod over a sterile drape. A PEER Retractor, Roto-Iok ratchet (5- or 10-mm diameter and 32-cm length) is placed intracorporeally to retract and position the kidney for hilar, upper, and lower pole dissection. The PEER retractor's handle is secured in place using the precision clamp of the instrument holder. The articulating instrument holder and PEER retractor are used for our renal, adrenal, and ureteral laparoscopic procedures. Placement of the retractor through a 5- or 10-mm port and deployment can be done quickly. Adequate and stable positioning of the retractor provides excellent and secure visualization of the operative field. These instruments have been used in more than 200 cases without any complication except 1 minor liver laceration. The articulating instrument holder with the PEER retractor is a very useful aid during laparoscopic renal surgery. This instrument reduces the chances of inadvertent injury to viscera by the assistant while maintaining an excellent anatomic view throughout the procedure. This will have a significant impact on the advancement of laparoscopy and its acceptance by every urologist.

KW - Adrenalectomy

KW - Kidney

KW - Laparoscopy

KW - Nephrectomy

KW - PEER retractor

KW - Retraction

KW - Ureteral surgery Endoholder

UR - http://www.scopus.com/inward/record.url?scp=14144254348&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=14144254348&partnerID=8YFLogxK

M3 - Article

C2 - 15714150

AN - SCOPUS:14144254348

VL - 15

SP - 18

EP - 21

JO - Surgical Laparoscopy, Endoscopy and Percutaneous Techniques

JF - Surgical Laparoscopy, Endoscopy and Percutaneous Techniques

SN - 1530-4515

IS - 1

ER -