What Tools are used in Laparoscopic Surgery?

Laparoscopic surgery uses long-pencil like instruments that fit through small cuts in the abdominal wall instead of large incisions required during open operations.

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Laparoscopic Instruments for a variety of purposes

Laparoscopic instruments are used along with a laparoscope, which is a thin telescope fitted with a cold light source and a video camera. Inert gases like carbon dioxide are used to inflate the abdominal region which increases the distance between the organs and the abdominal wall thus enlarging the operating field. Common instruments used during laparoscopic procedures include a: laparoscope, needle driver for suturing, trocar, bowel grasper and surgical mesh.

Laparoscope

Surgical scopes are one of the oldest instruments used by medical practitioners since ancient times. Modern surgical laparoscopes used for minimally invasive procedures are a far cry from the simple hollow tubes that gradually developed to include lenses for magnified vision. Today, scopes are more like an apparatus with multiple parts that include a CCD camera, viewing device, lens cleaner, and an energy-supply device.

Needle Driver

A needle holder is used by laparoscopic surgeons to hold suturing needles when closing wounds. Forming slip-knots to close wounds and surgical incisions requires precise skills. Suturing can often be tricky to use owing to the property of &#;memory&#; which causes tissue to resist deformation. Needle holders have three parts &#; the jaws, joints, and handles. The instrument is classified as straight or curved depending upon the shape of the jaws.

Trocar

Along with the probe, scalpel, and cannula the trocar is one of the oldest implements used by medical practitioners. A trocar is shaped like a pen and has a sharp triangular point. Trocars are typically placed inside hollow cannulas and introduced inside body cavities to assist in draining fluids. Trocars are now referred to as both the initial entry device as well as the hollow cannula used during the operation. These instruments play an important role in laparoscopic surgery. Instruments such as scissors and graspers are introduced using surgical trocars.

Bowel Grasper

A bowel grasper is used during minimally invasive bowel surgery. The graspers are maneuvered through incisions that are usually no larger than 5 mm. The advantage with using laparoscopic graspers is that they enable the surgeon to grasp and manipulate abdomen tissue with precision without having to cut open the abdomen. The graspers facilitate observation, excision, and biopsy procedures.

Surgical Mesh

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Hernia mesh is an implantable device that serves as scaffolding for your natural tissue to grow into and hence reinforce the area. The mesh itself only provides minimal support. It is your own tissue that is ultimately responsible for the repair. There are many different types of surgical mesh that can be used to repair hernias and other defects of the musculoskeletal system.

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Article Overview

The origins of laparoscopic surgery trace back to the introduction of diagnostic laparoscopy in the s. Subsequently, the approach underwent a notable evolution, transitioning from a primarily diagnostic procedure to a surgical technique. Laparoscopic surgery has become the gold standard for treating many pathologies such as symptomatic cholelithiasis, Crohn&#;s disease, and benign ovarian cysts.1, 2, 3 Laparoscopy, a type of minimally invasive surgery, was introduced to address issues related to significant tissue trauma, large cosmetic scars, and prolonged hospitalizations. Various studies have demonstrated that patients undergoing laparoscopic surgery have reduced risks of perioperative mortality and postoperative morbidity in comparison to individuals undergoing open surgery.4, 5 In order to achieve safe and effective surgical outcomes, the operators are required to have an in-depth understanding of the basic and specialized equipment required. 

This video provides a step-by-step demonstration of the assembly, disassembly, use, and handling of laparoscopic tools on the example of a basic Karl Storz laparoscopy kit.

A set of requirements are established to guarantee the efficient handling of the instrument in both the sterilization unit and the operating room. Modern laparoscopic instruments have a distinctive design that enables complete disassembly of each instrument, facilitating efficient cleaning and decontamination. Every modular instrument undergoes validation to ensure that it can be sterilized while fully assembled.

The video begins by introducing the three primary sections of laparoscopic instruments: the insert, the sheath, and the handle. The next part of the video explores three commonly used types of laparoscopic dissectors: the dolphin nose dissector, which has traditional micro-serrated tapered tips; the Maryland dissector with curved forceps, which is ideal for precise manipulations; and the laparoscopic right-angle dissector, which has cross-serrations on its angled tip for grasping tissues in hard-to-reach places. The assembly and disassembly of these dissectors are demonstrated, highlighting the importance of utilizing the tools with non-locking handles to allow for smooth surgeon maneuverability during procedures. The instruments must be completely opened, and the ratchet must be slid into position to activate the locking mechanism; a clear click is produced upon connection. Subsequently, the operator ensures proper functionality by opening and closing the instrument. When the surgeon slides a specific piece down, the ratchet comes into operation. When closed, the ratchet facilitates a secure hold, maintaining the closed position until intentionally released. The removal process involves opening the ratchet, pressing down on a designated button, and effortlessly sliding the handle off. The disassembly of the instrument is completed by twisting and separating the insert from the sheath. This modular design allows for convenient cleaning, maintenance, and potential replacement of individual components.

Next, the video provides a visual overview of medical graspers, which come in numerous variants, distinguished by the inner side of their jaws. Traumatic graspers feature deep serrations or toothed tips for secure gripping, ideal for rigorous procedures. On the other hand, atraumatic graspers have finely serrated inner jaws, providing a gentler touch suitable for delicate tasks involving fragile tissues. The importance of locking handles for graspers, particularly in situations requiring a secure grip, is visually underscored. 

A distinctive feature explored in the video is the integration of a Bovie, an electrosurgical device, with laparoscopic instruments. Viewers are visually guided through the steps of connecting the Bovie cord to the laparoscopic instrument handle, demonstrating the technique of efficient cauterization.

The sterilization of laparoscopic instruments is crucial, with procedures varying based on safety standards dictated by different countries. Before sterilization, these instruments undergo a meticulous process, including wiping down and spraying with enzymatic cleaner. An enzyme-based cleaner is an enzymatic detergent solution, penetrating the hard-to-reach parts of the equipment for thorough cleaning. This detergent offers distinct advantages, such as increased activity on proteins (like blood, feces, and mucous) through proteolytic enzymes, advanced formulations for quick and thorough penetration of organic matter, and a safe, biodegradable base that is gentle on both users and the environment. Following the cleaning process, items designated for disinfection must undergo a thorough rinse to remove any residual detergent. Subsequently, the instruments proceed to the final phase of sterilization.

This video is meant as an informative guide to laparoscopic instruments in the field of surgical technology. The step-by-step visual guidance through the assembly, use, and decontamination processes enhances the understanding of laparoscopic instruments.

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