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2019 - William Bolton

Gas Insufflation Less Laparoscopic Surgery (GILLS) for minimally invasive surgery in low-resource settings: Methods for evaluating surgical field of view (FOV) and abdominal wall lift (AWL) force - A Cadaveric Study Model

Aim: The aim of this study was to assess methods for evaluating surgical FOV and AWL force during GILLS.

Methods: A human Thiel cadaver was used to evaluate the device and load cell force sensor. The abdomen was insufflated with CO2 to 12mmHg and a 3D surface scan was taken. After removing gas another 3D surface scan was taken for comparison. Each surgeon using CLS and AWL performed diagnostic laparoscopy. A 3D scanner and mechanical force meter measured the actual force applied. A written questionnaire evaluated the usability and subjective FOV.

Results: Feedback: 100% (n=5) ‘GILLS gave adequate views when compared to CLS’
(n=3; 60%) disagreed ‘I spent more time to get good views during GILLS compared to CLS’.
(n=4; 80%) ‘The tool control was safe’, and
(n=4; 80%) disagreed ‘The GILLS apparatus was interfering 
with the surgical field’.
The headroom at umbilicus with CLS at 12 mmHg was 22mm compared to a GILLS mean headroom of 36mm.
In inferior sagittal plane, GILLS mean headroom remained high at 31.4mm.
In superior sagittal plane, GILLS mean headroom reduced significantly to -1.9mm, suggesting a tenting effect.

Conclusion: The results suggest that the operative FOV and usability of the AWL device are adequate for clinical use with minimal limitations.