Liver retraction system by C3-muco-adhesive polymer films for laparoscopic surgery.
Conventional laparoscopic instruments used for retraction may cause trauma at the retraction site. Alternative retraction/lifting especially of heavy solid organs such as the liver may be obtained by other means. The present study was designed to explore the use of C3-muco-adhesive polymers (C3-MAPs), which exhibit strong binding to the liver shortly after application to the organ and which retain strong adhesion for sufficient time, to enable sustained retraction during laparoscopic operations.



C3-muco-adhesive polymers were produced specifically for the study. In an ex vivo experimental set-up, discs of C3-MAPs were placed on the surface of porcine livers for adhesion and retraction studies involving objective measurements by tensiometry.



Experiments were carried out on 14 porcine livers. The force required to detach the C3-MAPs from the liver exceeded 2.0 N 30 s after application. The adhesion force by C3-MAPs files was sufficient to enable sustained retraction force necessary for exposure of the gall bladder, which was achieved by a mean retraction force of 4.85 N (SD = 0.63). This was sustained for a mean of 130 min (range 17.0-240.0). In the adhesion studies, the forces at 30 s required to detach the polymer discs from the liver exceeded 20 N (upper limit of the load cells of the Instron). The duration of the adhesion enabled sustained optimal gall bladder exposure for periods ranging from 17 to 240 min, with a mean of 130 ± 91 min.



The results of the present study demonstrate that the adhesion and retraction properties of the engineered C3-MAP films are sufficient to enable complete exposure of the gall bladder for a period exceeding 1 h, confirming their potential for atraumatic retraction in laparoscopic and other minimal-access surgical approaches.
Cuschieri Skills Centre, Institute of Medical Education, Ninewells Hospital, University of Dundee, Dundee, UK.
Saud
S
Aldeghaither
Cuschieri Skills Centre, Institute of Medical Education, Ninewells Hospital, University of Dundee, Dundee, UK. b.tang@dundee.ac.uk.
Benjie
B
Tang
Department of Surgery, Ninewells Hospital and Medical School, Dundee, UK.
Afshin
A
Alijani
Institute for Medical Science and Technology, University of Dundee, 1, Wurzburg Loan, Dundee, DD2 IFD, UK.
Donald
D
McLean
Department of Chemistry, St Andrews University, St Andrews, UK.
Emma
E
Wright
Institute for Medical Science and Technology, University of Dundee, 1, Wurzburg Loan, Dundee, DD2 IFD, UK.
Zhigang
Z
Wang
Cuschieri Skills Centre, Institute of Medical Education, Ninewells Hospital, University of Dundee, Dundee, UK.|Department of Surgery, Ninewells Hospital and Medical School, Dundee, UK.
Iain
I
Tait
Institute for Medical Science and Technology, University of Dundee, 1, Wurzburg Loan, Dundee, DD2 IFD, UK. a.cuschieri@dundee.ac.uk.
Alfred
A
Cuschieri
D000005:Abdomen; D000179:Acrylates / Q000627:therapeutic use*; D000818:Animals; D065347:Hypromellose Derivatives / Q000627:therapeutic use*; D010535:Laparoscopy / Q000379:methods*; D008099:Liver; D055595:Mechanical Phenomena; D020442:Poloxamer / Q000627:therapeutic use*; D013552:Swine; D014014:Tissue Adhesives / Q000627:therapeutic use*
D000179:Acrylates; D014014:Tissue Adhesives; C117167:carbopol 974P NF; D020442:Poloxamer; D065347:Hypromellose Derivatives
Adhesion; C3-muco-adhesive polymers; Laparoscopic surgery; Retraction