SPIDER and flexible laparoscopy: the next frontier in abdominal surgery

Area of Science:

• Minimally Invasive Surgery
• Surgical Technology
• Gastrointestinal Surgery

Background:

• Natural Orifice Translumenal Endoscopic Surgery (NOTES) introduced scarless surgery but carries risks, limiting mainstream adoption.
• Single-site surgery is viewed as a safer alternative to NOTES, but standard instrumentation presents technical challenges.
• Existing single-site approaches lack triangulation, instrument-camera conflict management, and pneumoperitoneum maintenance.

Purpose of the Study:

• To introduce the TransEnterix SPIDER platform as a solution for single-site laparoscopic surgery.
• To describe the hybrid flexible laparoscopic technique facilitated by the SPIDER platform.
• To share initial experiences and technical pearls for using the SPIDER system.

Main Methods:

• The TransEnterix SPIDER platform, a sterile, disposable device with 4 working channels, was utilized.
• A hybrid flexible laparoscopic technique was employed for various procedures.
• Over 100 cases were reviewed, including colectomy, cholecystectomy, and adjustable gastric banding.

Main Results:

• The SPIDER platform effectively overcomes technical challenges in single-site surgery.
• Initial experience in over 100 cases demonstrated the system's efficacy.
• Key technical pearls include adopting a 'pulling' rather than 'pushing' motion and increased electrocautery use.

Conclusions:

• The SPIDER platform facilitates safe and straightforward single-site laparoscopic surgery.
• The hybrid flexible laparoscopic technique offers advantages for minimally invasive procedures.
• Further understanding of the learning curve for flexible laparoscopy is provided.