Solo Surgeon Laparo-Endoscopic Single Site Nephrectomy Facilitated by New Generation Magnetically Anchored and Guided Systems Camera

Introduction: We report a redesigned magnetically anchored and guided systems (MAGS) camera with improved optics and a 30 degrees downward viewing angle that facilitates solitary surgeon laparo-endoscopic single site (LESS) nephrectomy. Methods: The prototype consists of an external 2 by 6 cm cylinder containing magnets positioned such that the intra-abdominal camera is anchored on the peritoneal surface with a default 30 degrees downward angle. It was inserted through a 3 cm LESS-port periumbilical incision in three pigs (mean 47 kg). The camera was coupled with the handheld magnetic device across the anterior abdominal wall and was steered into position to view the kidney. LESS nephrectomy was then performed. Results: Since a standard LESS laparoscope was not needed, only the two operative instruments were inserted through the single incision port, significantly decreasing instrument "clashing" compared with traditional LESS nephrectomy. Due to the favorable angle of view of the camera and its self-anchoring capability, no assistant was needed to drive the camera. Instead, the surgeon periodically made minor adjustments to optimize the view. The nephrectomy was completed without complication in an average of 35 minutes in these three nonsurvival animals. Conclusion: The MAGS camera provides good optics and easy maneuverability during LESS porcine nephrectomy. As with other MAGS instruments, by replacing a traditional transabdominal laparoscope that occupies access port space, use of this insertable camera may diminish some of the "collision challenge" of LESS surgery. Also, by being self-anchoring, this prototype may minimize the need for an assistant surgeon.