laparoscopy is recent advancing area in the field of general surgery. the identification and underlying mechanism of action of each laparoscopic instrument is necessary for their handling ans use.
2. ContentsContents
1. General description
2. Principals of laparoscopy
3. Composition of laparoscope
I. Equipment cart
II. Insufflating system
III. Imaging system
IV. Instrumentations
V. Electro-surgical-cautery
system
3. Laparoscopy
Laparoscopy is a technologically dependent
surgery comprising of computerized designed
instruments with microprocessor controlled safety
features.
Principal of laparoscopy
Identification of pathology and surgical
intervention is the solely principal of laparoscopy.
4. COMPOSITION OF A LAPAROSCOPE
1. Equipment cart
2. Insufflating system
3. Imaging system
4. Instrumentations
5. Electro-surgical-cautery system
5. Equipment cart
Multiple shelves for different equipments
1. Monitor shelf
2. Light source shelf
3. Co2 insufflators shelf
4. Electro-surgical shelf
6. Monitor shelf
Camera reader shelf
Co2 insufflators shelf
Light source shelf
Electro-surgical shelf
Figure: Equipment cart
7. Insufflating system
Insufflation system allows gas to fill the
abdominopelvic cavity to maximize visualization.
Insufflation system are designed to deliver the gas at
low as well as high pressure to ensure the constant set
intra-abdomino-pelvic pressure during surgery.
Insufflations tube with 0.3 micron filter is
recommended to prevent contamination with bacteria,
micro-particles and debris from insufflators and gas
tank.
8. CO2 Cylinders
Available sizes are
2.5 lb CO2 tanks
• 5 lb CO2 cylinders
• 7 lb CO2 tanks
• 10 lb CO2 cylinders
• 15 lb CO2 tanks
• 20 lb CO2 tanks
• 35 lb CO2 tanks
• 50 lb CO2 tanks
Figure: CO2 Cylinders
9. CO2 Cable:
It is flexible,
friendly use and
highly tensile in
strength to ensure
the proper
delivery of gas
from insufflators
to intra-peritoneal
cavity without
leakage.
Figure: CO2 Cable
11. Imaging system
1. Light source
2. Fiber-optic cable
3. Camera console
4. Endoscope/Telescope
5. Monitor
12. Light source
Three types are there
1. Halide
2. Halogen
3. Xenon
Halogen: 250 watts inbuilt
lamp and this is economical
Xenon: 175-300 watts lamp
and this is expensive Figure: Light source
13. LIGHT CABLES
There are two types of
light cables
Fluid filled cables and
fiber-optic cables
Fiber-optic cables
They conduct less heat
They are soft and sound to handle
They don’t produce hindrance
while handling camera console
They are easily autoclaved
Fluid filled cables
They conduct more heat
Stiffer and tough in nature
They produce hindrance while
handling camera console
They are difficult to be autoclaved
15. Camera console
The camera head consists of a goal lens, a prism assembly
and three sensors for acquiring the primary colors of the
image.
Optical zoom is advantageous because it doesn't have
negative effect on the look resolution.
White balancing and contrast
Zoom options
Digital enhancement options to create sharper images.
17. Endoscope/Telescope:
British physicist Hopkins invented in 1952.
Normally used telescope is the Hopkins Forward
Oblique Telescope 30°, diameter 10mm length 33cm,
and is autoclavable.
At the distal end is a front lens complex (inverting real-
image lens system, IRILS) which creates an inverted
and real image of the subject.
Forward viewing, 300 angled and 450 angled.
20. Monitor
Surgical monitors are no different from the T.V. We watch at home.
The existing television systems in use differ according to the country.
The U.S.A uses the NTSC (National Television System Committee)
system.
In European countries the PAL (Phase Alternation by Line) system is in
use.
There is also a French system called SECAM (Sequential color and
memory).
The broadcasting standards for each are summarized below:
Standard resolution monitors have 400 lines
High definition monitors have 1200 lines.
22. Handling devices
It contains following parts
i. Tip
ii. Insulated outer tube
iii. Rotator
iv. Attachment for electro-surgical
cord
v. Rachet for locking
24. TROCAR
A trocar is a laparoscopic device that is made up of
an obturator (which may be a metal or plastic
sharpened or non-bladed tip) and a cannula (basically a
hollow tube).
Trocars are placed through the abdomen
during laparoscopic surgery.
The trocar functions as a portal for the subsequent
placement of other instruments, such as graspers,
scissors, staplers, etc
26. What should be the good qualities of a
handling device?
It is usually 33 cm long
Jaws to be adequately elastic to perform atraumatic
handling
Easy to disassemble and reassemble
Parts should be interchangeable between similar
instruments
Easy cleaning and sterilization
Simple design with minimum number of hinges and bolts
27. Scissors
Reposable scissors: They combine reusable handle with
disposable scissor. They can be straight or curved scissors.
Reusable scissor: They combine reusable handle and reusable
scissors. They can be straight or curved scissors.
These scissors are called Metzenbaum scissors
Types
Straight scissor
Micro curved scissor
Hook scissor
33. Dissectors
Most commonly used is Maryland dissector.
Maryland dissector:
· Maryland dissector instrument is inserted through 5 mm trocar.
· Dissector comes with long, curved jaws and fine-tapered tips
· Dissectors used mainly for separation of sac from cord structures
·Also finding use for other blunt dissection purposes
· Rotating shaft for allowing easy dissection with lesser strain to surgeon's
wrist
· Sharp and insulated scissor finish
· As a monopolar electrosurgical instrument it finds use for dissection and
hemostasis using flexible endoscopes with working channel
36. Clip applicator
This is used to ligate the vessels and ducts. The
applicator is first loaded with metallic clip and then
clip is applied by applying pressure to handle of the
instrument.
38. Veress needle
A Veress needle is a spring-loaded needle used to
create pneumoperitoneum for laparoscopic surgery.
The tool was first developed in 1932 by Janos Veres,
a Hungarian internist.
Modern needles are 12 to 15 cm long, with an external diameter of
2 mm.
The outer cannula consists of a beveled needle point for cutting
through tissues of the abdominal wall. A spring-loaded, inner stylet is
positioned within the outer cannula. This inner stylet has a dull tip to
protect any viscera from injury by the sharp, outer cannula.
40. Suction and irrigation cannula
This tube is essentially used in case of antra-
abdominal leakage in order to was out the
affected area.
This is three way cannula in which one end is used
for suction, another for irrigation and third one for
being placed in abdominal cavity.
