Dr. Greenberg is Chief, Division of Gynecology, Brigham & Women’s Faulkner Hospital, and Associate Professor, Harvard Medical School, Boston, Massachusetts.
Dr Greenberg test drives 2 new products to see if they can be of use in your practice.
The views of the author are personal opinions and do not necessarily represent the views of Contemporary Ob/Gyn.
Dr Greenberg personally tests all the products he reviews. He has no conflicts of interest with these products or the companies that produce them.
Clear-Trac V Vaginal Retractor
The LED revolution is upon us and it is high time that operating rooms opened their eyes to the reality that illuminating the deepest crevices of the human body is no longer the domain of the classic over-hanging OR lights but rather the cool, white lumens emitted by disposable LED “bulbs” on point-of-contact instruments.
Whether on retractors, suction-irrigators, speculums, or headlamps, short-life LED devices will soon be to surgeons what wifi is to electronics: results without wires. The Clear-Trac V vaginal retractor is part of this burgeoning niche market.
It is hard to imagine a simpler medical device than Clear-Trac V. In essence it is an L-shaped piece of rigid plastic with an LED-bulb welded to it. It comes in one size: 140 mm x 53 mm, and it is powered by a low-voltage mercury-free alkaline button battery that allows the device to be disposed of as regular, nontoxic medical waste (after exposure to bodily fluids, etc). Don’t look for more, that’s it. The device is intended as a single-use product and comes in an individual sterile packet with 25 devices per box. It is simple, lightweight, and intuitive.
In clinical use, Clear-Trac V provided outstanding light and tissue retraction. I used it during a vaginal hysterectomy to retract the sidewalls and for the first time in many years, I actually saw all the deeper tissues without having to shift my fat head out of the light. While it is not sufficient to completely replace overhead lights, Clear-Trac V is more than adequate to replace the headlamps with the Twenty Thousand Leagues Under the Sea umbilical cords that these require. As the product catches on, I would expect a broader line of retractor options, but for now this is a pretty good start.
My biggest complaint is the relatively short battery life (only about 30 minutes of peak power). While the battery life can be preserved by replacing the tab, this is annoying and I took away a star for this reason. Also, my green soul prefers reusables to disposables but, given the importance of good light in surgery, I think this small contribution to the landfill is worth it.
DESIGN/FUNCTIONALITY SCORE: ***
Clear-Trac V is not overwhelmingly innovative. In fact, I was blown away that this technology is not already available from a broad array of vendors. That said, until there was Velcro there was no Velcro, so hats off to OBP for coming up with this because I do believe it will change the market.
INNOVATION SCORE: ****
Clear-Trac V is a really good device for getting light into deep spaces. It is simple, intuitive, and relatively inexpensive. For pelvic surgeons who don’t get the light they want or are still using headlamps, this product is definitely worth a try. When coupled with one of the illuminated suction-tips on the market, Clear-Trac V will provide better visualization of deeper spaces than most of what is being used today.
OVERALL SCORE: ****
MiniLap Percutaneous System with MiniGrip handle
In the MIGS, SILS, LESS, NOTES race to the smallest and fewest, I am not sure what counts. A 5-mm trocar definitely counts as a port. A 20-G (0.9081 mm) spinal needle definitely does not count as a port. What about 2.4 mm? We’ll need to decide because Teleflex’s MiniLap Percutaneous System is ready to grab some attention.
With an outer diameter of 2.4 mm, the MiniLap instruments with the MiniGrip are amazingly thin but surprisingly strong and versatile. All the instruments in the line are sterile, single-use, and come with an integrated, retractable needle tip that allows for direct percutaneous insertion of the device without a trocar. The line comes with 2 handle styles-MiniGrip pistol style or standard 3-finger grip. There are also 4 jaw options, each with a wingspan of 12.5 mm that is more than adequate to grasp most tissues.
In the OR, the MiniLap generally performed better than I expected (which is rare). The shaft was much more durable than I anticipated and the grip on the tissues was superb. I liked the rotatable functionality and I thought the pistol-grip was ergonomically comfortable. And the incision -forget about it (because I almost did it was so unnoticeable)!
The only thing I did not like was the mechanism to retract the grasper and arm the needle for percutaneous insertion. I thought it was sticky, somewhat persnickety, and in general felt a little fragile. Because I suspect this will be easily remedied in future iterations, I am not too concerned.
DESIGN/FUNCTIONALITY SCORE: *****
MiniLap is a game-changer in disposable laparoscopic instruments. Its incredible strength-to-shaft ratio makes it very useful as a surgical tool and its 2.4 mm-ness is amazing. The device looks and feels so similar to other devices that it is difficult to give it that fifth star but that should not diminish the accomplishment of getting all that punch into such a small package.
INNOVATION SCORE: ****
The MiniLap Percutaneous System is a real winner. For surgeons looking to do more with less this is a must. Want better triangular for “single-port” procedures? Use this. Struggling and need another hand to move tissues out of the way? This is your answer. Does 2.4 mm count as a port? I say no. Should your hospital be stocking this device? I say yes.
OVERALL SCORE: *****