In March 2012, Bariatric Solutions introduced a re-useable retrogastric dissector for single hand tissue tunnelling during bariatric procedures. Called the PinkyTrigger, the laparoscopic 5mm instrument is easy to use and incorporates a dynamic lever facilitating the curve the tip of the instrument to a maximum angle of 130° in an uninterrupted fashion.
Bariatric News spoke to Dr Paul Super, Birmingham, UK, who has performed over 200 laparoscopic gastric band procedures with the PinkyTigger, to discuss the benefits of using the device.
“This device has several key benefits - specifically the rigidity of dissection and retrogastric passage of instrument,” he says. “We use the device for Lap band dissection and band delivery. The PinkyTrigger enables a one-on-one transition from the lever to tip of the instrument and works like an extension of your own finger.
The PinkyTrigger can also be operated with one single hand instead of two compared with some of the other available retrogastric dissectors.
Super explains that the dissection is more smooth in the retro-gastric plane as the operator can probe and push the device at the same time as flexing the instrument to secure the path of least resistance. This can be achieved without snagging areolar tissue behind the stomach, as usually occurs with similar instruments.
According to Super, the device is particular useful in superobese patients as it more robust, providing the user with greater leverage and more precise dissection compared with disposable devices, which are limited due to instrument torque.
“In many ways it is like trying to get a lobster out of a shell using a steel fork or a plastic fork,” he said. “Whereas the steel fork will give you the strength required, the plastic will flex and bend. So the PinkyTrigger is much more robust, particular in the superobese patient.”
The device also curls back up to at least 130º - a significant advantage in super-obese patients, since the tip directs well up over the angle of His towards the camera to engage the tip more conveniently than in other dissectors of this type.
The PinkyTrigger is cost-effective as it is re-usable with a validated disinfection and sterilisation process, avoiding the high costs associated with repeated purchase of disposable devices.
“For an initial cost of approximately €2,500, the device pays for itself within about 20 procedures,” says Super. “The device could be used to perform hundreds of cases before any form of instrument maintenance is required cases. In my opinion, it is far more cost-effective than the disposable alternatives, such as the Gold Finger from Ethicon and the similar AMI device.”
Although the device is easy to use with no learning curve and is simple to direct and manoeuvre, Super offers some advice for surgeons using the PinkyTrigger: “I always deploy the device by inserting it through an epigastric port and in a peri-crural plane just under the myomesium of the crura. The tip passes from right crus to left crus in the direction of the angle of His. This allows a smooth passage behind the stomach in a bloodless plane.”
The device has already made an impact at Super’s institution and he believes that the PinkyTrigger will be readily adopted by additional surgical specialties, not just bariatric surgeons, for their laparoscopic cases.
“I think the device can be applied to other laparoscopic bariatric procedures such as gastric bypass and sleeve as a curved dissector. It is very useful instrument to use as a blunt probe, manoeuvring tissue, in and around the Hiatus,” claims Super. “One of the big users of this device in our hospital are colorectal surgeons, who use it as a retraction and dissection device when they are performing laparoscopic colorectal surgery. Everyone should have a PinkyTrigger when performing laparoscopic surgery because of its versatility.”