A novel device for aspiration and irrigation in endovideosurgery: flexible head for aspirator-irrigator with memory effect

BACKGROUND: Aspiration of biological fluids, including blood and urine, as well as irrigation of the surgical field are important tasks at any stage of the majority of abdominal surgical interventions. These functions are necessary to prevent contamination of the abdominal cavity, clean the surgical field from fluid accumulations and blood clots, which in turn allows for optimal visualization for the operating surgeon. During endovideosurgical partial nephrectomy, maintaining a clean surgical field and adequate visualization of the resection area is often a difficult task, especially with posterior tumors. This is due to difficulties in reaching the resection zone due to insufficient instrument length and/or instrument bending.

AIM: The aim of the study is to study the properties of a new flexible nozzle for an aspirator-irrigator during kidney resection on a model of the intraabdominal space using a pig organ complex.

MATERIALS AND METHODS: The nozzle for the aspirator-irrigator is made of polyvinyl chloride, has the shape of a straight hollow tube 80 mm long and 6.5 mm in diameter; on the inner side surfaces there are two channels with a diameter of 1 mm, in which brass rods are located, giving the structure rigidity, with the possibility of changing it forms with a “memory effect”. This nozzle is attached to the distal end of a standard metal tube of the aspirator-irrigator, after which the surgeon gives it the necessary bend, sufficient to penetrate into hard-to-reach areas of the surgical field. Using a pig organ complex and a laparoscopic simulator, a model of the abdominal cavity and retroperitoneal space was created. Laparoscopic instruments were used to simulate an endovideosurgical operation. Using laparoscopic scissors, a wedge-shaped resection of a section of the renal parenchyma (with a suspected tumor) was performed. Aspiration tubes were brought to the formed parenchymal defect — first a standard straight metal tube, then an aspiration tube with a flexible tip, which was previously given the necessary bend. At the end of the experiment, the effectiveness of using the new device in conditions of hard-to-reach localization of the resection zone, its safety for surrounding tissues and organs, as well as its convenience for the surgeon were assessed.

RESULTS: The effectiveness of the new attachment for resection of a suspected posterior renal tumor in a simulated intraabdominal space using a porcine organ complex. The access, aspiration, and irrigation were difficult and took longer time with using of the standard aspirator-irrigator tip, than with the new flexible tip.

CONCLUSIONS: The new flexible aspirator-irrigator head provides safe and rapid access to difficult-to-reach partial nephrectomy sites, as well as efficient aspiration and irrigation.