Development of a transabdominal anchoring system for trocar-less laparoscopic surgery

Compared with open surgery, laparoscopy results in significantly less pain, faster convalescence, and less morbidity. However, eye-hand dissociation, a two-dimensional field-of-view and fixed instrumentation with limited degrees of freedom contribute to a steep learning curve and demanding dexterity requirements for many laparoscopic procedures. One of the main limitations of laparoscopy is the fixed working envelope surrounding each trocar, often necessitating placement of multiple ports to accommodate changes in position of the instruments or laparoscope to improve visibility and efficiency. The placement of additional working ports contributes to post-operative pain and carries a small risk of bleeding or adjacent organ damage. In order to provide for greater flexibility of endoscopic viewing and instrument usage and to further reduce morbidity, a novel adjunct laparoscopic system has been developed consisting of a platform capable of supporting various laparoscopic tools which is secured magnetically to the abdominal wall and subsequently positioned within the abdominal cavity through surgeon-controlled, external magnetic couples on the patient's abdomen. Using this technique, instruments such as miniature endoscopic cameras used to augment the surgical field of view and surgical retractors have been successfully evaluated in a dry laboratory as well as in porcine models, with several others currently under investigation. This document elaborates on the theoretical and empirical process which has led to anchoring designs optimized for size, strength and surgical compatibility, as well as the benefits, limitations and prospects for the use of incisionless, magnetically-coupled tooling in laparoscopic surgery.