As a young physician, training at the prestigious Cleveland Clinic, it did not take Terive Duperier long to understand one simple concept; more transfascial stitches equates to more post-operative pain experienced by the patient. After co-founding the Bariatric Medical Institute of Texas, Dr. Duperier currently functions as the co-director of the fellowship program. Having performed thousands of cases, Dr. Duperier is a strong advocate for efficient laparoscopic specimen extraction, and he advocates for fewer stitches so that there is less post-operative pain.

With the advancement of laparoscopic, and the development of robotic surgery, the challenge of extracting large specimens through increasingly smaller and smaller port-sites became increasingly prevalent. The specialized equipment required for a “scarless laparoscopy” is rendered insignificant when a massive specimen is forced through a minuscule port site. Along with post-operative pain, a common complication following these procedures is hernias.

When presented with the challenge of extracting a large specimen through a small port site, most clinicians will use a finger or a Kelly clamp to manually dilate the port site. This often leaves a jagged tear of the peritoneum (and the patient with more pain), which is more to difficult to approximate and close, elevating the risk of herniation. Other issues that are mitigated are the immediate and rapid loss of pneumoperitoneum, which causes annoying blood splatter to the clinician’s face and impaired visualization due to loss of peritoneum.

Dr. D understood these complications and set out to discover a better, safer solution for his patients. His early experiments with a scalpel often left his fingers in peril, and the potential for the sharp being dislodged from the handle by a trocar flap made that option too risky. After countless hours of thought, experiment, and prototype invention, Dr. D created a beautifully simplistic device. A blunt ended, 10 mm “ghost stick” (to preserve pneumoperitoneum), that can fit down a robotic trocar track with a retractable scalpel to be deployed by a button on the handle.

Now known as Progressive Medical’s Extractor-EZ® and renowned nationwide, this device assists clinicians in specimen extraction in minimally invasive cases. The mission is to create a precise, easily approximated incision of the fascia that will reduce post-operative pain, and decrease the risk of herniation, while preserving pneumoperitoneum and eliminating blood splatter. The Extractor-EZ® is a retractable scalpel designed for insertion into a trocar site. With the blade retracted, the surgeon can maintain pneumoperitoneum while guiding the blunt shaft of the device into position under direct vision with the camera. It is a simple device, but a game-changer in laparoscopic and robotic procedures.

In this demonstration PMI Extractor EZ® & PMI Superbag®, Dr. D uses the PMI Extractor-EZ in conjunction with a 7 mm PMI SUPERBAG® to remove a gallbladder in a robotic cholecystectomy. Dr. D inserts the PMI Extractor-EZ® into the track of the robotic trocar, and safely, under direct visualization, he deploys the blade and creates a precise linear incision to widen the port site, without loss of pneumoperitoneum or blood splatter, and extracts the gallbladder. Using the PMI SiteClosure, Dr. D easily approximates the defect and can close with fewer stitches, less patient pain, and less scaring.

From training at the Cleveland Clinic, to co-founding the Bariatric Institute of Texas, Dr. Terive Duperier continues to address one simple concern; more stitches equate to more post-operative pain experienced by the patient.

The design of the Extractor-EZ® aims to improve patient outcomes through achieving a better approximation of fascial defect closure, reducing the risk of hernia and post-operative pain for patients.