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 Improving surgical efficiency with the dynamic grasper: a cost-effective and innovative solution for optimizing exposure in minimally invasive surgery
Treerat Tangpulphon1,2,3orcid, Chucheep Sahakitrungruang1,2orcid
Annals of Coloproctology 2025;41(3):246-247.
DOI: https://doi.org/10.3393/ac.2024.00913.0130
Published online: June 24, 2025

1Division of Colorectal Surgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

2Chulalongkorn Colorectal Research Unit, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

3Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand

Correspondence to: Chucheep Sahakitrungruang, MD Chulalongkorn Colorectal Research Unit, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Pathum Wan, Bangkok 10330, Thailand Email: chucheep.sa@chula.ac.th
• Received: December 4, 2024   • Revised: January 16, 2025   • Accepted: January 27, 2025

© 2025 The Korean Society of Coloproctology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Achieving optimal exposure of the surgical field in minimally invasive surgery is essential, but it can be particularly challenging during lengthy procedures [1]. Assistant fatigue may compromise tissue traction, while the assistant’s position opposite the surgeon often creates counterintuitive instrument movements. Robotic surgery mitigates these issues by enabling a single surgeon to control all robotic arms, thereby enhancing exposure. Although robotic techniques achieve postoperative outcomes comparable to conventional laparoscopy [2, 3], they incur high costs and require extended docking times—especially in multiquadrant surgeries—while still necessitating a human assistant near the patient cart. Furthermore, both human and robotic assistants provide rigid retraction, which risks losing tension during prolonged dissection. This necessitates repeated instrument adjustments and increases susceptibility to tissue trauma from inadvertent patient or assistant movements.
The dynamic grasper, an innovative secondary assistive tool, addresses these limitations. Composed of a standard grasper affixed with silk and a rubber band, the device is secured to the surgical drape using a towel clip. Its elastic properties enable “dynamic exposure,” maintaining consistent tissue tension during dissection and minimizing the need for repositioning.
Our video presentation illustrates the dynamic grasper’s application in a laparoscopic left hemicolectomy for a 68-year-old male patient with descending colon adenocarcinoma, performed by a single surgeon and camera operator (Supplementary Video 1). Written informed consent was obtained from the patient. Key steps included lateral-to-medial colon mobilization, splenic flexure release, and vascular dissection [4]. The device was utilized to achieve optimal exposure of the surgical field by stretching the rubber band in the desired direction and anchoring it to the drape. Elastic traction provided continuous exposure, facilitating precise dissection.
Multiple dynamic graspers may be used simultaneously for optimal field visualization. Repositioning graspers on the same anatomical target—such as during splenic flexure mobilization—requires no adjustment to the rubber band’s anchor point, streamlining workflow compared to coordinating with an assistant. For areas demanding bidirectional retraction (e.g., inferior mesenteric vein dissection), 2-point fixation applies multidirectional force. Unlike human or robotic assistants, the device remains effective across all abdominal quadrants, even when patient positioning changes. Complete mesocolic excision and central vascular ligation were achieved with minimal blood loss. The patient resumed oral intake on postoperative day 1 and was discharged on day 4 without complications.
A limitation of this technique is the need for periodic intraoperative grasper adjustments by the surgeon. By contrast, an experienced second surgeon providing active traction may reduce operative time through nuanced retraction.
In conclusion, the dynamic grasper offers an innovative solution constructed from low-cost, readily available materials (silk and rubber bands). It delivers continuous, adaptable traction with a strong safety profile. Multiple units can be deployed to optimize exposure of the surgical field across diverse surgical scenarios, offering a versatile alternative to human or robotic assistance without compromising efficiency.

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Funding

None.

Author contributions

Conceptualization: all authors; Methodology: all authors; Visualization: all authors; Writing–original draft: all authors; Writing–review & editing: all authors. All authors read and approved the final manuscript.

Supplementary Video 1.

Improving surgical efficiency with the dynamic grasper: a cost-effective and innovative solution for optimizing exposure in minimally invasive surgery.
Supplementary materials are available from https://doi.org/10.3393/ac.2024.00913.0130.
  • 1. Ladwa N, Sajid MS, Pankhania NK, Sains P, Baig MK. Retraction techniques in laparoscopic colorectal surgery: a literature-based review. Colorectal Dis 2013;15:936–43. ArticlePubMed
  • 2. Ngu JC, Kim SH. Robotic surgery in colorectal cancer: the way forward or a passing fad. J Gastrointest Oncol 2019;10:1222–8. ArticlePubMedPMC
  • 3. Simianu VV, Gaertner WB, Kuntz K, Kwaan MR, Lowry AC, Madoff RD, et al. Cost-effectiveness evaluation of laparoscopic versus robotic minimally invasive colectomy. Ann Surg 2020;272:334–41. ArticlePubMed
  • 4. Morris MC, Paquette IM. Laparoscopic left colectomy: surgical technique. Ann Laparosc Endosc Surg 2019;4:18.Article

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        Improving surgical efficiency with the dynamic grasper: a cost-effective and innovative solution for optimizing exposure in minimally invasive surgery
        Ann Coloproctol. 2025;41(3):246-247.   Published online June 24, 2025
        DOI: https://doi.org/10.3393/ac.2024.00913.0130
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