ACCESS ABILITIES How hard do your access devices work for your surgeons and for patients' outcomes?

Laparoscopic surgery depends on access. Trocars and ports serve as conduits for cameras; grasping, dissecting, cutting and sealing instruments; mesh positioners; staplers and a host of other devices reaching in to treat the otherwise untouchable surgical site in the abdominal cavity.

The narrower instruments and smaller incision sizes that support minimally invasive surgery shrink the necessary diameter of these access ports and, consequently, their impact on surgical patients' tissue, a benefit which sparked the concept of single-incision laparoscopy, in which one port does the job.

But as surgical techniques and surgical access have miniaturized, a single port now has to play many roles. Simply delivering access isn't enough: Ports must offer other functional advantages as well, as surgical innovators and medical device manufacturers have recently realized. For example, one access device manufacturer also offers a way to ensure predictable incision closing outcomes.

When is a port not a port? When it's actually 3 or more ports. Or when it's also an insufflation device. Or when it's part of a multi-tasking laparoscopic management system.

Among the recent developments to hit the access market:

• a reusable trocar, designed to be as easy to take apart and clean as it is easy on your supply budget;
• a multiple-port access device that's been reduced in size but doesn't reduce instrument articulation;
• trocars that can accommodate versatile combinations of instrument sizes;
• a port that warms insufflation gas to benefit the surgeon and patient; and
• a port that provides access, pressure, insufflation and filtration in one system.

See the next page for some of the recent innovations that are making access more than just access.

— David Bernard

Aesculap
Reusable Trocar System
aesculapusa.com
(800) 282-9000
Pricing: not disclosed
FYI: Aesculap's Reusable Trocar System offers an alternative to disposable trocars, delivering laparoscopic access while reducing both case costs and waste. Available in 3.5mm, 5mm, 10mm and 12mm diameters, the lightweight trocars are modular, enabling easy disassembly for thorough reprocessing. Color-coded components make reassembly a snap. The 3mm and 5mm trocars are ideal for single-port procedures, says Aesculap, which offers single-use, bladeless dilating and fully reusable obturators to use with them.

Applied Medical
GelPoint Mini Advanced Access Platform
appliedmedical.com
(800) 282-2212
Pricing: $400 to $500
FYI: The GelPoint Mini adapts the company's GelPoint multiple-access, single-incision port device to the growing demand for smaller incisions and patient cosmesis without limiting instruments' range of motion. The flexible, airtight fulcrum, designed for 1.5cm to 3cm incisions (down from the GelPoint's 1.5cm to 7cm) in abdominal walls of varying size enables a triangulation of standard 5mm to 10mm instruments while maintaining the pneumoperitoneum for continuous access and visualization.

Lexion Medical
InsuFlow Synergy
lexionmedical.com
(877) 9-LEXION
Pricing: $95 to $105
FYI: Lexion Medical's InsuFlow laparoscopic gas conditioning device warms and humidifies the CO2 that's insufflated into a patient's pneumoperitoneum, with an eye on reducing the fog that can obstruct a surgeon's vision and the post-op pain that can prolong a patient's recovery. Its InsuFlow Synergy incorporates those abilities and advantages into a 5mm instrument port. Like the insufflation line attachment, the pink port delivers 95 ? F, 95% relative humidity CO2 and maintains pneumoperitoneum stability through multi-directional vents on its distal end, which flow consistently even when instruments are inserted.

Olympus America
TriPort Access System
olympusamerica.com/less
(800) 548-5515
Pricing: not disclosed
FYI: The Olympus TriPort+ (pictured), TriPort15 and QuadPort+ access devices, part of the company's Laparo-Endoscopic Single-Site (LESS) line of surgical technologies, enable physicians to perform multiple-port procedures through a single umbilical incision in abdominal walls of up to 10cm thick. The devices' flexible ports simultaneously accommodate straight, curved and articulating instruments of varying diameters to reduce clutter and improve cosmesis. A duckbill-style valve design allows instrument introduction and removal without depleting the pneumoperitoneum, while a removable top makes specimen retrieval unobtrusive and a retraction sleeve protects the wound.

SurgiQuest
AirSeal System
surgiquest.com
(877) 509-3947
Pricing: IFS unit, $29,500; access ports, $97 to $117, depending on diameter and length; tri-lumen tube set, $110
FYI: SurgiQuest says its AirSeal System is more than a trocar, more than an insufflator, more than a filter: It's an integrated abdominal cavity stability system that combines and improves on all 3 for reduced procedure times. An invisible, horizontal air barrier inside the access port (available in 5mm, 8mm or 12mm diameters) provides valve-free access for smudge-free scope insertion and intact specimen removal. The IFS (Intelligent Flow System) unit ensures a stable pneumoperitoneum, even during constant suction. The tri-lumen tube set continuously evacuates smoke while filtering and recirculating CO2.

Teleflex
Weck EFx Endo Fascial Closure System
teleflex.com
(866) 246-6990
Pricing: about $100
FYI: Teleflex's Weck line of access devices offers not only a wide assortment of Vista bladeless access ports for clear visualization and minimal tissue trauma upon entry, but also the EFx Endo Fascial Closure System, which facilitates uniformly reproducible closure results for port sites 10mm or larger. The system, designed to accommodate practically any patient body type, helps to minimize the risk of post-op port-site herniation. A suture passer and the device's guide channels present controlled suture delivery with little risk of needlestick injuries, while internal features capture the suture ends for consistent closure.