Lowering the Barrier of Surgical Endoscopy With a Novel Articulating Retractor

Abstract

Surgical endoscopy has gained traction over the past several decades as a viable option for therapeutic interventions in the gastrointestinal tract. It utilizes natural orifice access which shortens hospital stay, minimizes patient discomfort, and decreases overall healthcare costs. However, the inability to effectively retract and position target tissue is a significant limitation for these procedures. Current instruments are unable to triangulate and can only be manually withdrawn or advanced through the channels. There is a need to provide better access and control of soft tissue to be able to perform more complex and complete endoscopic resections. We have developed a novel device to provide optimal tissue retraction for endoscopic procedures. Our device consists of an articulating tissue retractor and a specialized handle. Two articulating curves were created that can manipulate the position and direction of the retractor tip. Each curve is independently adjusted by locking thumb sliders, allowing for increased range of motion and retraction independent of endoscope position. With a diameter of 2.8 mm, the proposed device can be used in current endoscopic equipment. Preliminary testing showed that our retractor has comparable slip strength to a commercially available device (1.13 N ± 0.53 N versus 1.10 N ± 0.51 N, p-value: 0.416), but has much greater range of motion (maximum deflection of 72 deg compared to 0 deg). This increased range of motion allows the articulating grasper to better triangulate and preserve visualization of the dissection plane, allowing it to overcome the most significant barrier restricting endoscopic surgery.