Laparoscopic Instruments
Laparoscopic Instruments
Surgery to be simple with Dr/ [Link]
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Laparoscopic Instruments
Laparoscopic Instruments
Surgery to be simple with Dr/ [Link]
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Laparoscopic Instruments
Introduction
▪ Laparoscopic surgery, also called minimally invasive surgery (MIS):
− A modern surgical technique in which operations are performed far
from their location through small incisions (usually 0.5-1.5 cm)
elsewhere in the body.
▪ Three main components:
1) Image production.
2) Pneumoperitoneum.
3) Laparoscopic instruments.
Laparoscopic Instrumentation
1. Optical Devices.
2. Equipment for creating/maintaining domain.
3. Instruments for Access.
4. Operative instruments.
5. Energy sources.
6. Tissue approximation/hemostasis.
7. Miscellaneous.
1. Optical Devices:
1) Telescope:
• This endoscope is made of surgical stainless steel containing an optical lens.
• Telescopes or laparoscopes come in various sizes 10mm, 5mm, 2-3mm
‘needle scopes’ and with various visualization capabilities such as zero-
degree forward viewing, 30- or 45-degree telescope, zero degree
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Laparoscopic Instruments
2) Light Source:
• White light illumination is provided from a high
intensity xenon, mercury, or halogen lamp and
delivered via A fiberoptic bundle. MCQ
3) Video Camera:
• The resolution or clarity of the image depends upon the number of pixels or
light receptors on the chip.
• Standard cameras in laparoscopic use contain 250,000 to 380,000 pixels.
4) Television Monitor:
• High-resolution video monitors are
required for suitable reproduction of
endoscopic image.
• Three chip cameras require monitors
with 700 lines resolution to realize the
improved resolution of extra chip
sensors.
• VHS recorder, video printer and sometimes DVD recorder are standard
documentation equipment housed in the video cart.
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Laparoscopic Instruments
Surgery to be simple with Dr/ [Link]
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Laparoscopic Instruments
2. Equipment for creating/maintaining domain:
Gas insufflation: “MCQ”
• CO2 Insufflator: The creation of working space in the abdominal cavity is
generally done using CO2 delivered via an automatic, high flow, pressure
regulated insufflator.
• Q: CO2 is currently the agent of choice due to ???
1) Low risk of gas embolism.
2) Low toxicity to peritoneal tissues.
3) Low cost.
4) Rapid reabsorption.
5) Inhibits combustion.
• Level is usually set at 12 to 15 mm Hg.
3. Instruments for Access:
Veress needle:
• The Veress needle is designed to create
pneumoperritoneum prior to insertion of trocar in a
closed fashion.
4. Operative Instruments:
1) Trocars:
• Available in various diameters and sizes according to
requirements, 10mm and 5 mm being commonly used.
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Laparoscopic Instruments
2) Graspers:
• Retraction may be achieved using large instruments.
3) Dissectors:
• Maryland Dissector has long, curved jaws
with fine tapered tips. Ideal for precise
dissection (resembles the Crile hemostatic
clamp used in open surgeries.)
4) Scissors:
• There are a variety of scissors for dissecting,
mobilizing and cutting tissues, which include
straight and curved types.
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Laparoscopic Instruments
5. Energy Sources:
1) Electrosurgery:
• Electrocautery refers to direct current whereas electrosurgery uses
alternating current.
• During electrocautery, current does not enter the patient’s body. Only the
heated wire comes in contact with tissue.
Bipolar Monopolar
• In bipolar electrosurgery, both the • The active electrode is in the
active electrode and return wound.
electrode functions are performed at • The patient return electrode is
the site of surgery. attached somewhere else on the
• The two tines of the forceps perform patient.
the active and return electrode • The current must flow through
functions. the patient to the patient return
• Only, the tissue grasped is included electrode to complete the circuit.
in the electrical circuit.
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Laparoscopic Instruments
2) Ultrasonic Energy: (The Harmonic scalpel):
• Uses ultrasonic technology, the unique energy form that allows both cutting
and coagulation at the precise point of impact, resulting in minimal lateral
thermal tissue damage.
• Cuts and coagulates by using lower temperatures than those used by
electrosurgery or lasers.
6. Instruments for Tissue approximation/ Hemostasis:
1) Needle holder: 2) Endo-stitch:
3) Clip Applicators:
• Clip appliers are primary modality for
ligating blood vessels and other tubular
structures.
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Laparoscopic Instruments
4) Mechanical Stapling Instruments:
• Laparoscopic staplers are modifications
of stapling devices of open surgery.
• Staplers are used for transecting and
anastomosing bowel, transecting mesentery etc.
7. Miscellaneous:
1) Aspiration/Irrigation probes:
• These are essential for most laparoscopic
procedures in order to maintain a clear operative
field.
• Irrigation and aspiration channels may be
incorporated into surgical instruments but
working channels are small and subject to repeated clogging.
2) Organ Extraction devices:
• Preloaded specimen retrieval pouches:
✓ Made of strong material, which is impervious to
cancer cells. The mouth of the pouch is bought
out of the incision site and opened following
which the specimen is extracted.
• Tissue Morcellators:
✓ These are used to reduce the size of the
resected specimen prior to retrieval.
✓ It may render pathological examination more
difficult.
✓ E.g. Laparoscopic myomectomy.
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Laparoscopic Instruments
Surgery to be simple with Dr/ [Link]
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