gms | German Medical Science

Introduction: When operating laparoscopically the surgeon often encounters difficulties in exposing the surgical field adequately. These situations make the need for inserting a 4^th or even 5^th trocar inevitable in order to remove different organs and structures out of the field. Hereby we want to present an innovative technique which facilitates the necessary exposure drastically, without using additional trocars. It is the Ney Lift.

Methods: From 01.2011 to 02.2021 we performed laparoscopic sacropexy by using 4 trocars (1 optic + 3 working trocars) till 09.2015 by using 3 trocars (1 optic + 2 working trocars + Ney-Lift) in 866 patients: 699 were performed laparoscopically with a reusable helical tunnelling device, 9 were operated with the DaVinci using standard instruments and 158 were performed laparoscopically using standard instruments. In all cases a macroporous polypropylene mesh was used. We place the port in a usual manner (10 mm umbilical camera port and two 5 mm lateral trocars). Equipment needed: 10 cm hollow needle – 3x 0 monofil suture – cotton pieps. We place the suture through the needle and hold both end of the suture in the dominant hand. Next we insert the needle through the abdominal wall at the level we want to retract structure. Using a laparoscopical grasper we grasp the arch of the suture and pull it toward the structure. We place the “lasso” around the salpinx and the assistant pulls the extracorporeal ends of the suture, thus retracting the structure towards the abdominal wall, outside the operating field. We place a pieps on one end of the suture and make a surgical knot in order to secure the structure to the abdominal wall.

Results: The mean treatment time was 60 min (45-75 min) by using NEY-LIFT and only 3 Trocars (1 optic trocar, 2 working trocars). The mean treatment time was 70 min (45-97 min) by using 4 Trocars (1 optic trocar, 3 working trocars). Learning curve for usage the NEY-Lift was 2. The average operation time using NEY-Lift was significantly reduced by 15min, although one trocar was used less. Due to the better visibility through the Ney-Lift and the lower number of trocars, the assistant only had to operate the camera. This optimized the surgical procedure.

Conclusion: The Ney Lift is a novel and simple way of exposing the operating site appropriately without using further trocars. It is a step towards performing an even more minimally invasive and atraumatic laparoscopic surgery and reduce the treatment time.