Tina Thomas1, Daniel H Teitelbaum1, Ranjith Vellody2, Dragan Spremo2, Samual Elkins2, Robert Ladouceur2, David Nagy2, Marcus D Jarboe3,4. 1. Section of Pediatric Surgery, Department of Surgery, Mott Children's Hospital, University of Michigan, 1540 East Hospital Drive, SPC 4211, Ann Arbor, MI, 48109-4211, USA. 2. Department of Pediatric and Interventional Radiology, C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI, USA. 3. Section of Pediatric Surgery, Department of Surgery, Mott Children's Hospital, University of Michigan, 1540 East Hospital Drive, SPC 4211, Ann Arbor, MI, 48109-4211, USA. marjarbo@med.umich.edu. 4. Department of Pediatric and Interventional Radiology, C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI, USA. marjarbo@med.umich.edu.
Abstract
BACKGROUND: MRI-guided laparoscopic assisted anorectoplasty (MRI-LAARP), a new approach for surgical correction of high imperforate anus, does not bisect the sphincter complex as in the PSARP and is able to pull the neorectum through the entire sphincter complex unlike the LAARP. There is no available MRI-compatible device to position and transport patients during this procedure. We report on the design of such a device here. METHODS AND DEVICE: The device was constructed from 1.0″ polyvinylchloride tubing and poly-methyl methacrylate (Plexiglass(®)) platform. The device has a stable, rigid base on which platform is secure. An adjustable and removable superstructure is secured to this base to suspend legs for lithotomy position. RESULTS: MRI-LAARP has been performed on 6 patients. The device has performed well and meets requirements set forth in development including construction with MRI-compatible materials, size fitting in the MRI bore, ability to hold patient in lithotomy position, ability to position and support MRI flex coils, and providing stability while transporting to a separate OR with needle in position. CONCLUSIONS: This device provides a stable structure to position and transport a patient with a needle in a tenuous position without dislodgement allowing this procedure, and potentially other procedures, to be done in hospitals without MROR capability.
BACKGROUND: MRI-guided laparoscopic assisted anorectoplasty (MRI-LAARP), a new approach for surgical correction of high imperforate anus, does not bisect the sphincter complex as in the PSARP and is able to pull the neorectum through the entire sphincter complex unlike the LAARP. There is no available MRI-compatible device to position and transport patients during this procedure. We report on the design of such a device here. METHODS AND DEVICE: The device was constructed from 1.0″ polyvinylchloride tubing and poly-methyl methacrylate (Plexiglass(®)) platform. The device has a stable, rigid base on which platform is secure. An adjustable and removable superstructure is secured to this base to suspend legs for lithotomy position. RESULTS: MRI-LAARP has been performed on 6 patients. The device has performed well and meets requirements set forth in development including construction with MRI-compatible materials, size fitting in the MRI bore, ability to hold patient in lithotomy position, ability to position and support MRI flex coils, and providing stability while transporting to a separate OR with needle in position. CONCLUSIONS: This device provides a stable structure to position and transport a patient with a needle in a tenuous position without dislodgement allowing this procedure, and potentially other procedures, to be done in hospitals without MROR capability.
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Authors: Tina T Thomas; Daniel H Teitelbaum; Ethan A Smith; Jonathan R Dillman; Ranjith Vellody; Marcus D Jarboe Journal: Pediatr Surg Int Date: 2016-10-08 Impact factor: 1.827