AUA 2019: First Clinical Evaluation of a Novel Magnetic Retraction Device during Reduced Port Robotic Assisted Radical Prostatectomy
Beyond the platform itself, however, companies are working on innovations that affect the tools used during the robotic case and during laparoscopic cases. One such innovation that is explored in this abstract is the LMSS (Levita Magnetics, San Mateo CA) magnetic retraction system. Excellent videos of their technology can be found on their website above. In essence, however, magnetic retraction “has the potential to increase the benefits of minimally invasive surgery, as this innovative technology enhances exposure, meanwhile reducing invasiveness. The system allows for un-constrained, shaft-less magnetic retraction, overcoming the limitations of conventional surgical instruments.” It essentially allows placement of a grasper on a tissue/organ of interest, then releases the head of the grasper internally; an external magnet can be moved around to shift the internal grasper – preventing the need for additional ports, cluttering of instruments, etc.
This technology has already been approved for use in bariatric surgery and laparoscopic cholecystectomies. Early clinical results showed reduced pain, fewer complications, fewer scars and shorter length of hospital stay in general surgical procedures. Just recently it has been approved for Robotic prostatectomies.
In this study, which is the first prospective clinical trial that combines magnetic retraction in urological procedures, the purpose was to evaluate the safety and effectiveness of the Levita Magnetic Surgical System (LMSS) in patients undergoing prostatectomy surgery. It was designed as a prospective single-arm study. All adverse events (AE) were captured and summarized by relatedness to the device and/or procedure, seriousness and level of severity. The primary effectiveness endpoint was the ability to adequately retract the prostate to achieve an effective exposure of the target tissue. The adequate retraction was deemed to be achieved if it was not necessary to replace the LMSS with another instrument to perform the procedure.
The authors conducted the study on 30 subjects who underwent robotic prostatectomy. All the cases were performed with 5 ports, per the usual protocol of the group. The average procedure time was 3 hours and 23 minutes and the average amount of time that the device was in the abdomen was 1 hour and 47 minutes.
In all of the 30 cases, the LMSS was able to adequately retract the prostate (and/or peri-prostatic tissue) to achieve an effective exposure of the target tissue. In 28 of the 30 cases, patients had organ-confined disease, and a nerve-sparing technique was effectively performed.
Eleven AE were reported (ten mild and one moderate) and all resolved with no clinical sequelae. No AE was reported as device-related.
Overall, this appears to be a safe tool to use for radical prostatectomy – and indeed, may have applications for numerous urologic procedures.
Presented by: Matthew Gettman, MD Urologist, Rochester, MN
Co-Authors: Jorge Diaz, Alvaro Vidal, Camilo Sandoval, Pedro Recabal, Jaime Altamirano
Author Affiliation: Rochester, MN
Written by: Thenappan Chandrasekar, MD (Clinical Instructor, Thomas Jefferson University) (twitter: @tchandra_uromd, @JEFFUrology) at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois