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View Video ViewAttendees 2

Session: Ongoing Videos

VM9 - Optimizing Laparoscopic Pelvic Lymph Node Dissection with a Dynamic Grasper

ONGOING VIDEOS
Location: San Diego Convention Center, ASCRS Connect Lounge, Hall B1/B2, Ground Level

    Video Presentation(s)

  • Kitrawee Jirathaniruangkit, MD

    Fellowship
    Chulalongkorn Colorectal Research Unit, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
    King Chulalongkorn Memorial Hospital
    Lumlukka, Pathum Thani, Thailand

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • CS

    Chucheep Sahakitrungruang, MD, MSc

    Professor of Surgery
    Chulalongkorn Colorectal Research Unit, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
    Bangkok, Krung Thep, Thailand

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Kitrawee Jirathaniruangkit, MD: This individual has no financial relationships with ineligible companies.
Chucheep Sahakitrungruang, MD, MSc: This individual has no financial relationships with ineligible companies.
Purpose/Background: Minimally invasive lateral pelvic lymph node dissection (LPLND) is complex due to surrounding vulnerable structures and the challenge of surgical exposure. Human-assisted traction is unsteady, causing the risk of tissue injury and insufficient exposure. Robotic-assisted surgery offers advantages, though it comes with significant costs. Using dynamic grasper, an ordinary grasper enhanced with rubber band and silk anchoring by a towel clip, allows achieving effective dynamic traction and optimal exposure through the rubber band’s elasticity, eliminating the need for surgical assistant. This study demonstrates laparoscopic LPLND using a dynamic grasper, carried out solely by the surgeon and the camera assistant.

Methods/Interventions: A 33-year-old female patient was diagnosed with mid-rectal cancer and left obturator lymph node enlargement. She underwent total neoadjuvant treatment, followed by dynamic grasper-assisted laparoscopic low anterior resection with left LPLND and diverting loop ileostomy. Following rectal transection, LPLND was performed, with optimal exposure achieved using two dynamic graspers. At one point, a dynamic grasper was introduced to lift the dissected lymph nodes tissue, providing improved exposure in that area. The procedure was accomplished with minimal blood loss.

Results/Outcomes: There were no perioperative complications. The pathological examination revealed pT1N0 adenocarcinoma, with all negative lateral pelvic lymph nodes (0/12). The patient was discharged on postoperative day five.

Conclusion/Discussion: With the use of dynamic grasper, laparoscopic LPLND can be successfully performed without human-assisted traction. This study confirms the safety and feasibility of using the dynamic grasper in complex laparoscopic surgeries. We recommend this simple and cost-effective innovation for adoption in global surgical practice.

Laparoscopic lateral pelvic lymph node dissection using dynamic graspers
The dynamic grasper provides dynamic traction (moving autonomously) by gradually adjusting the tension during dissection and synchronizing with the patient’s movements. The entire procedure was performed by only one surgeon and one camera operator.


The dynamic grasper: an ordinary grasper enhanced with rubber band and silk