The New Surgical Instrument in Peritoneal Endometriosis Resection

Purpose: Peritoneal resection for the therapy of oncological diseases as well as endometriosis is associated with major problems as injury to neighboring organs and difficulties in the establishment of the necessary hemostasis. In this paper we present a new dissection tool, the “Jet Grasper” (KARL STORZ), which represents a further step towards simple, safe and effective laparoscopic peritoneal resection. Methods: The “Jet Grasper”, was developed to enable selective dissection of the peritoneum and, if necessary, other organs in the case of adhesions. For the tissue resection different techniques can be applied (e.g. ultrasound, mechanical or electrosurgical energy). Results: The tool features a dissection forceps with a narrow slit at the end of the jaw. Further selective dissection is achieved by applying water pressure retroperitoneally via a controlled water pressure pump. Furthermore a diameter difference between the jaw and the sheath potentiates dissection. The thin jaws are introduced precisely to separate and/or dissect layers in a physiological manner to enable further dissection of the peritoneum at a safe distance. Larger vessels can subsequently be targeted for bipolar coagulation in the opened retroperitoneal area. As we are exclusively presenting a completely new device, no patient data are included here. However, a prospective randomized study already started in April 2012, and will be reported after completion in two years. Conlusion: The new dissection tool combines selective dissection and resection under controlled water pressure, known from aquadissection. It provides enhanced and atraumatic possibilities in performing pelvic peritoneal resection via selective dissection and reduction of blood loss.