An original and effective technique to improve exposure in open surgery
© The Author(s). 2017
Received: 6 March 2017
Accepted: 5 June 2017
Published: 20 June 2017
Exposure, especially when the organs are enlarged, remains one of the most important issue in open surgery. Considering this constraint appears critical in the progress of the surgical procedure. We highlight our technique which affords optimal exposure and improves manipulation and extraction of enlarged organs.
This original and effective technique is derived from an obstetrical device used to perform an assisted vaginal delivery. It improves exposure, reduces tissue manipulation, and enhances removal of the surgical specimen during hysterectomies and myomectomies. It can be similarly helpful sometimes to grasp and remove (by mini laparotomy) enlarged adnexa during laparoscopic procedures. Moreover, this trick appears particularly suited in case of obese patients.
This new technique procures a real benefit for both the patient and the surgeon in terms of ergonomics and safety.
Exposure, mainly when the organs are enlarged, remains one of the most important issue in open surgery. Taking into account, this constraint appears critical in the progress of the surgical procedure, in terms of ergonomics and security, particularly.
Material and methods
In our practice, we use a trick with which exposure and maneuvering are facilitated. The use of a disposable Kiwi OmniCup® delivery device (Clinical Innovations®, Murray, Utah, USA) is a simple method to enhance exposure in open surgery, providing optimization of the operating space with adequate manipulation of the surgical specimen. This device, commonly used by obstetricians to perform an assisted vaginal delivery (instrumental extraction), is also used during a difficult fetal extraction by cesarean section [1–3]. It is a plastic, cup-shaped instrument which is applied to the fetal head after verification of the absence of vaginal wall (in case of vaginal delivery) and uterine wall (in case of cesarean section) in the suction area. As opposed to other surgical instruments, it does not increase the fetal head diameter for delivery. These advantages can be used in open surgery procedures. Indeed, the limited size of the device and the mobility of its traction system can release the operative field and facilitate the utero-adnexal exposure and extraction during open surgical procedures. Moreover, the laparotomy incision size is reduced because it is not necessary for the hands of the surgeon (or any instrument) to grasp the organ by surrounding it. Thus, this technique avoids the need for potentially hemorrhagic gests as traction sutures, or traumatic maneuvers, as surgical retractors whose use can lead to significant postoperative pain and even bowel, bladder, or parietal injuries. The use of a screw when performing a hysterectomy by laparotomy seems less ergonomic since this instrument does not allow all the degrees of freedom that the vacuum cup provides. In addition, the vacuum cup avoids any hysterotomy, and thus any tearing of the serous and the muscularis of the uterus. These points can thus represent advantages in terms of bleeding and carcinological safety. Additionally, the use of a single-use suction cup simplifies the sterilization logistics.
Results and discussion
Surgical technique (Additional file 1)
This original and effective technique is exploited to improve exposure, reduce tissue manipulation, and enhance removal of the surgical specimen. In this sense, it procures ergonomics and safety representing a real benefit for both the patient and the surgeon.
Additional file 1: Vacuum cup in laparotomy. (MP4 194252 kb)
EN contributed to the conception and design, data collection, drafting of the manuscript, and video editing. GC took part in the critical revision of the manuscript to be submitted. Both authors read and approved the final manuscript.
The authors declare that they have no competing interests.
Ethics approval and consent to participate
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
- Riethmuller D, Ramanah R, Maillet R, Schaal JP (2008) Vacuum extractors: description, mechanics, indications and contra-indications. J Gynecol Obstet Biol Reprod (Paris) 37(Suppl 8):S210–21View ArticleGoogle Scholar
- Deruelle P¨, Quest-Bothuyne E, Depret S, Subtil D (2007) Five questions about the Kiwi OmniCup vacuum extractor. Gynecol Obstet Ferti 35:582–6View ArticleGoogle Scholar
- Hayman R, Gilby J, Arulkumaran S (2002) Clinical evaluation of a “hand pump” vacuum delivery device. Obstet Gynaecol 100:1190–5Google Scholar