Rehman J et al. (2005) Instrumentation for Laparoscopic Renal Surgery—Padron Endoscopic Exposing Retractor (PEER) and Endoholder: Point of Technique. Surg Laparosc Endosc Percutan Tech 15: 18–21

The use of laparoscopy in urological surgery is increasingly favored because of its association with reduced postoperative pain, shorter hospital stay and decreased recovery period compared with open surgery. The achievement of adequate exposure is particularly important during laparoscopic procedures because of factors including diminished haptic feedback, loss of three-dimensional visualization and the challenge of maintaining appropriate force and position of the retractor.

Combined use of an adjustable spring-loaded articulating instrument holder (Endoholder®, Codman, Raynham, MA) and the Padron Exposing Endoscopic Retractor (PEER) (J. Jamner Surgical Instruments Inc, Hawthorne, NY) in laparoscopic nephrectomy is described by Rehman et al. in a recent paper. Following intracorporeal placement through a 5 mm or 10 mm port, the retractor is secured in place with the Endoholder® and can be used to facilitate hilar, upper and lower pole dissection of the kidney. The paper reports the complication rate for the combined use of the two instruments in renal, adrenal and ureteral laparoscopy as one minor complication in over 200 cases.

The authors conclude that the technique allows safe and effective retraction of the kidney, liver and spleen during laparoscopic surgery, thereby providing reliable exposure in addition to obviating the need for a surgical assistant to perform retraction. They propose that the resultant reduction in operation time might facilitate greater uptake of laparoscopic techniques by urologists.