A new "Perforator Grinder-Aspirator Apparatus (PGAA)" for the minimal access surgery of cystic liver hydatidosis

Despite that minimal access surgery is a feasible, effective and viable option for radical surgical treatment of cystic hydatidosis, the laparoscopic approach is not widely accepted because of the risk of recurrence and the risk of severe complications, such as anaphylaxis and/or contamination of the peritoneal cavity related with the spillage. To overcome these difficulties, several techniques and devices are described in the literature. In our center (ISTEM), we have designed and developed a new generation "Perforator-Grinder-Aspirator Apparatus (PGAA: patent no. TR-2004/02916)" which evacuates cyst contents in a more secure, effective and easy way. By using PGAA, we are able to perform the laparoscopic approach while keeping the necessary pneumoperitoneum pressure to evacuate the cyst contents of liver hydatidosis securely and effectively, with wider indications even in difficult locations, after testing its safety and efficacy in some ex-vivo animal livers with hydatid cysts. PGAA is made up of four main units including puncture-irrigation needle, perforator-grinder pipe, aspiration cannula and, electric motor. One of the most important specialties of this new PGAA is having the automatically retractable rotary blade on the distal edge to grind and evacuate all the contents of the cavity including germinal layer and scolices. Having the retractable rotary blade allows the operator to avoid any intracystic parenchymal damage after perforating the outer layer. After taking out the perforator-grinder pipe, the aspiration cannula allows the laparoscopic visualization of the inner surface of the cystic cavity through its 10-mm internal diameter. In this article, the author describes the technical aspect and specifications of PGAA, and its applications in some cases with awkwardly located liver hydatid cysts, underlying its superiority over the classical aspirators and other devices.