title: Feasibility of a combined percutaneous laparoscopic three-millimeter device.
abstract: OBJECTIVE
  Needlescopic 3-mm instruments induce minimal trauma and produce excellent cosmetic results. A combination of a 3-mm abdominal wall incision and a 5-mm instrument in the abdominal cavity would combine the beneficial features of these two different sizes.
  
  
  METHODS
  The Percutaneous Surgical System (PSS) (Ethicon EndoSurgery, Galway, Ireland) is a new instrument consisting of a 3-mm shaft that is introduced percutaneously into the abdominal cavity. Through a 5-mm trocar, a loader with a 5-mm attachment such as a Maryland dissector is introduced. The attachment is connected to the shaft, and the loader is removed from the abdomen. The feasibility of this device was evaluated retrospectively in 3 Swedish hospitals between January and September 2012.
  
  
  RESULTS
  Twenty-eight patients were laparoscopically operated on (cholecystectomy, gastric bypass, fundoplication, incisional hernias, and totally extraperitoneal repair for inguinal hernia) by use of 1 or 2 PSSs in each operation (47 in total). It was feasible to use the PSS in all procedures except during the totally extraperitoneal repair procedure because of the limited available preperitoneal space. Especially in laparoscopic cholecystectomies, the two lateral 5-mm trocars were easily replaced by two 3-mm PSS instruments.
  
  
  CONCLUSIONS
  The use of the PSS is feasible in a number of laparoscopic procedures, where it can replace 5-mm trocars. Randomized controlled trials are needed to determine the future role of the PSS versus, for example, needlescopic laparoscopy.
authors.affiliation: Department of Surgery, Södertälje Hospital, SE-15286 Södertälje, and CLINTEC, Karolinska Institutet, Stockholm, Sweden. Sven.bringman@ki.se.
authors.forename: Sven
authors.initials: S
authors.lastname: Bringman
authors.affiliation: Department of Surgery, Frölunda Specialist Hospital/Department of Gastrosurgical Research & Education, University of Gothenburg, Västra Frölunda, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Dalenbäck
authors.affiliation: Surgical Department, Umeå University, Sundsvall, Sweden.
authors.forename: Arthur
authors.initials: A
authors.lastname: Jänes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004066:Digestive System Diseases / Q000601:surgery*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult