Fine tilt tuning of a laparoscopic camera by local magnetic actuation: Two-port nephrectomy experience on human cadavers

Background: Magnetic surgical camera is an emerging technology having the potential to improve visualization without taking up port site space. However, tilting downward/upward the point of view can be obtained only by constantly applying a pressure on the abdomen. This study aims to test the hypothesis that the novel concept of Local Magnetic Actuation (LMA) is able to increase the tilt range available for a magnetic camera without the need for deforming the abdominal wall. The hypothesis that two-port laparoscopic nephrectomy in fresh tissue human cadavers could be performed by using the LMA camera is also tested. Methods: Firstly, the two cameras were separately inserted, anchored, and moved inside the inflated abdomen. Tilting angles were quantified by image analysis, while intra-abdominal pressure changes were monitored. Then, 5 two-port nephrectomies were performed by using the LMA camera while collecting quantitative outcomes. Results: The magnetic camera required a constant pressure on the magnetic handle to achieve an average of ±20 ° tilt from the horizontal position with an average of 7 mmHg loss of intra-abdominal pressure. The LMA camera allowed for 75 ° of tilt from the horizontal position with a resolution of ±1°, without any need to deform the abdomen. All the nephrectomies were completed successfully within an average time of 11 minutes. Conclusion: LMA is an effective strategy to provide magnetic cameras with wide-range and high-resolution vertical motion without the need of deforming the abdominal wall