The central challenge in minimally invasive surgery is figuring out how to do more with less. Restricted by the closed walls of the abdomen, surgeons need to find clever workarounds for common problems when traditional solutions are inadequate. A typical example is retraction. When working in the pelvis, even with a patient in Trendelenburg position, the bowel and omentum are frequently unwelcome guests to the surgical field party. Lacking a surgical resident or stuffed lap pads, surgeons typically introduce laparoscopic “fan” retractors through 5-mm or 12-mm ports and expand the instruments to provide manual retraction of the bowel. That technique is straightforward and effective but ties up both a port and a hand in accomplishing a task that is only tangentially related to the surgical focus. The T’Lift (VECTEC) is a low-tech solution to this high-tech problem.
Design and functionality
The design and appearance of T’Lift are so simple that you might expect to find it at a hardware store rather than in an operating room (OR). The device consists of cut fishing line, a needle to get the T’Lift where you want it, and a plastic tag to keep it there. More specifically, the three separate components are: a 2-mm non-resorbing, biocompatible thermoplastic string with a cut that opens into a “T” at one end, a hollow 2-mm introducer needle, and a plastic slide clamp.
Here’s how the device works: The “T” end of the plastic thread is straightened and inserted into the introducer needle. The needle loaded with the T’Lift is passed through the abdominal wall and then through the tissue to be retracted (for bowel retraction, passing the device through the epiploica rather than the bowel wall is recommended). Once the tip of the needle is through the target tissue, the T’Lift is advanced forward until the “T” is deployed. The introducer needle is then withdrawn, leaving the “T” end through the tissue and the other end outside the abdomen. The outside end is then retracted until the tissue is where the surgeon wants it and the lock is secured against the outside of the abdominal wall. Each T’Lift will retract up to 1500 g (3 lb). To remove it, the device is loosened and cut. The “T” end is grasped with a laparoscopic instrument and removed through any port.
In the OR, T’Lift was as simple and straightforward to use as it appears. It was quick and easy to deploy and it did exactly what it was designed to do: retract. It was simple to remove. In the case of the T’Lift, WYSIWYG (what you see is what you get).
Because I am rarely 100% satisfied, I did have two complaints/suggestions. The first is concerning the T’Lift’s color. The translucent wheat-pasta beige has no impact on functionality but it could become a huge issue if the device got lost in the abdomen. For that reason, I think the manufacturer should switch to a more vibrant color that would be easier to spot, should an errant piece of the device drop before it is removed. Second, I was disappointed to get only 2 devices in a pack. With a cost of goods that can’t be more than 4 or 5 cents, give me four devices, please.
I think that the T’Lift is brilliantly uncomplicated. A lot of us may want to believe we could have thought of this and should have thought of this, but we didn’t.
T’Lift is a simple answer to a sometimes challenging problem. While it is unlikely to dramatically alter minimally invasive surgery, it is a neat device to have in your surgical armamentarium. Its list price is a bit steep for only 2 devices but list prices are rarely the same as average sale price and, with increased sales, the price should come down. T’Lift is easy to stock, easy to use, and definitely worth a try.
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