Category: Laparoscopic/ Robotic: Bladder
Introduction & Objective : The Levita® magnetic surgical system developed by Levita Magnetics® is a minimally invasive retractor used for intra-abdominal surgical retraction in the laparoscopic or robotic surgical setting. The retractor is deployed into the abdomen using standard laparoscopic trocars and held in place with the assistance of an extra-abdominal magnet, thus reducing the need for an additional incision or port solely for the purposes of retraction or exposure. To our knowledge, no prior attempt has been made to assess the usefulness of this device in the setting of a robotic cystectomy. Our objective is to share our experience using the retractor to complete a robotic radical cystectomy in a female patient.
The retractor was used during the robotic cystectomy of a 71-year-old female with pT2N0M0 urothelial carcinoma of the bladder. It was deployed into the abdomen after the robot was docked and applied throughout the case when additional assistance with retraction was deemed helpful. The retractor can be repositioned intra-abdominally with the robotic grasper after the extracorporeal magnet is disengaged and moved to the next desired location. At the end of the case, the retractor can be removed with ease by magnetically attaching it to the applicator probe through the surgical assist port.
The Levita® retractor was first used to help mobilize the sigmoid colon. Next, the grasper was positioned to pull the peritoneum superiorly while the fourth arm of the robot retracted medially, greatly assisting in exposing the ureter for dissection. The enhanced ureteral retraction also eased the process of dissection around the ovaries and fallopian tubes. Once dissected, the ureter was isolated with a vessel loop that was clipped with a Hem-o-lock® clip. We used this as a handle to which the Levita retractor was attached. While holding the ureter up, the abdominal magnet allows for easy mobilization of the ureter laterally and medially to assist with safe dissection around the iliac vessels. In this capacity our dissection planes were easier to visualize. Finally, during the hysterectomy portion of the case, the retractor helped pull the uterus anteriorly at an angle difficult to duplicate with the robotic fourth arm.
We found the Levita® magnetic retractor most useful in peritoneal and ureteral retraction for ureteral dissection and in the retraction of the uterus and fallopian tubes. As a second retraction device to compliment the robotic fourth arm, the Levita® retractor can improve visualization, safety, and efficiency if used appropriately in the robotic setting.