Basic Laparoscopy

Instrumentation
Basic Laparoscopy and Instrumentation, Sadashiv Patil, 1st ed, 2016
Basic Laparoscopy and Instrumentation, Sadashiv Patil, 1st ed, 2016
 CAMERA

Head camera control unit (CCU)

Basic Laparoscopy and Instrumentation, Sadashiv Patil, 1st ed, 2016

Telescope Tip

Basic Laparoscopy and Instrumentation, Sadashiv Patil, 1st ed, 2016

PROBLEM
Fogging is a problem encountered during surgery; warm saline is used
to clean the lens with a gauze piece. Carbon dioxide (CO2), which is
used for insufflations is at lower temperature (Fig. 2.7).

Basic Laparoscopy and Instrumentation, Sadashiv Patil, 1st ed, 2016

 Light Source
Xenon 300 watt is the commonly used light source.
Xenon lamps use fused quartz as envelope with thoriated tungsten as
electrodes.
Fused quartz withstands high temperature and high pressure.

Light source Xenon arc light

Basic Laparoscopy and Instrumentation, Sadashiv Patil, 1st ed, 2016
Halogen tungsten lamp

Basic Laparoscopy and Instrumentation, Sadashiv Patil, 1st ed, 2016

FIBER OPTIC CABLE

Basic Laparoscopy and Instrumentation, Sadashiv Patil, 1st ed, 2016

INSTRUMENT

Basic Laparoscopy and Instrumentation, Sadashiv Patil, 1st ed, 2016

Basic Laparoscopy and Instrumentation, Sadashiv Patil, 1st ed, 2016
Basic Laparoscopy and Instrumentation, Sadashiv Patil, 1st ed, 2016
Basic Laparoscopy and Instrumentation, Sadashiv Patil, 1st ed, 2016
TROCAR

Basic Laparoscopy and Instrumentation, Sadashiv Patil, 1st ed, 2016

Basic Laparoscopy and Instrumentation, Sadashiv Patil, 1st ed, 2016
 Reducer
Reducer are the instruments (Figs 3.43 to 3.45) used to convert
the 10 mm cannulas to 5 mm.
It will help in maintaining the pneumoperitoneum, whenever
there is change in the instruments from larger to smaller diameter.

Basic Laparoscopy and Instrumentation, Sadashiv Patil, 1st ed, 2016

CLIP APLICATOR

Basic Laparoscopy and Instrumentation, Sadashiv Patil, 1st ed, 2016

 Suction Irrigation System
Even a small quantity of blood in the peritoneal cavity
will absorb light and cause insufficient illumination.
blood collection in the peritoneal cavity has to be
avoided
It has to be used adequately as there will be sudden loss
of pneumoperitoneum.

Basic Laparoscopy and Instrumentation, Sadashiv Patil, 1st ed, 2016

 Veress Needle
Veress needle Janos Veress

Basic Laparoscopy and Instrumentation, Sadashiv Patil, 1st ed, 2016

Ligating Loop

Basic Laparoscopy and Instrumentation, Sadashiv Patil, 1st ed, 2016

 Tacker
Tackers are mechanical fixation
devices used in surgery.
While
applying the tackers, counter
pressure has to be applied for the
tacker to fix properly.

Basic Laparoscopy and Instrumentation, Sadashiv Patil, 1st ed, 2016

 INSUFFLATORS
The intra-abdominal pressure should be maintained at 1214 mm of
Hg in order to avoid complications of gas embolism and decreased
venous return due to pressure on inferior vena cava
Modern insufflators (Figs 4.1 and 4.2) infuse gas in the peritoneum at
a predetermined rate by electronic mechanism. They monitor the
intraabdominal pressure constantly, the flow stops on reaching the
set pressure and resumes when the pressure decreases due to
leakage or suction

Basic Laparoscopy and Instrumentation, Sadashiv Patil, 1st ed, 2016

 The first column indicates the set intraperitoneal pressure, this is
done by the surgeon.
The second column indicates the rate of flow, which is also set flow.
The third indicator shows the amount of gas utilized (in liters)

Basic Laparoscopy and Instrumentation, Sadashiv Patil, 1st ed, 2016

 Ideal Insufflating Agents
1. Insufflating agent should be inert, colorless and noninflammable.
2. High solubility in the blood.
3. It should be cheap, easily available and nontoxic.

air,
carbondioxide,
nitrous
oxide,
helium,
argon

Basic Laparoscopy and Instrumentation, Sadashiv Patil, 1st ed, 2016

 Electrocautery
Monopolar Electrosurgery
The circuit consists of the generator, active electrode, patient and
patient return electrode The patients tissue provides the impedance,
producing heat
Active electrode is in the wound
Return electrode is elsewhere on the patient
Current must flow through the patient.

Basic Laparoscopy and Instrumentation, Sadashiv Patil, 1st ed, 2016

 In bipolar electrosurgery, one of the prongs acts as active electrode
and the other acts as a return electrode.
They are separated by few millimeters. The current passes only in
tissue between the two prongs.
It does not pass through the patients body as in monopolar surgery

Basic Laparoscopy and Instrumentation, Sadashiv Patil, 1st ed, 2016

 Harmonic and Vessel
Sealing Device
The handpiece incorporates the transducer and is connected to the
generator through an electric cable
The ferroelectric ceramic crystals of the transducer vibrate (expand
and contract) and produce ultrasound waves
The harmonic scalpel (Figs 7.5 and 7.6) works at a lower temperature
than the electrosurgical devices, since it denatures proteins by
mechanically breaking down the hydrogen bonds in protein molecules
when the blade vibrates at 55.5 kHz.
The temperature never exceeds 80C, the tissue charring effect is nill

Basic Laparoscopy and Instrumentation, Sadashiv Patil, 1st ed, 2016

Basic Laparoscopy and Instrumentation, Sadashiv Patil, 1st ed, 2016
TROUBLESHOOTING IN LAPAROSCOPY
AND REMEDIES

Basic Laparoscopy and Instrumentation, Sadashiv Patil, 1st ed, 2016

TROUBLESHOOTING IN LAPAROSCOPY
AND REMEDIES

Basic Laparoscopy and Instrumentation, Sadashiv Patil, 1st ed, 2016

TROUBLESHOOTING IN LAPAROSCOPY
AND REMEDIES

Basic Laparoscopy and Instrumentation, Sadashiv Patil, 1st ed, 2016

TROUBLESHOOTING IN LAPAROSCOPY
AND REMEDIES

Basic Laparoscopy and Instrumentation, Sadashiv Patil, 1st ed, 2016

METHODS OF PERITONEAL ACCESS
1. Veress needle technique.
2. Direct trocar insertion.
3. Optical trocar insertion.
4. Open technique (Hasson).
The first two are blind and the last two are performed under vision.
Closed Technique with Veress Needle

SAGES manual, volume 1, 3rd ed

SAGES manual, volume 1, 3rd ed
 Confirmation of the
Position
Drop test:
Percussion:

The rate of flow of CO2 is decided by the diameter of

the Veress needle, which is normally, 2.5 L/min. Normally, 2.53 L of CO2 is
sufficient for filling the peritoneal cavity
Open Technique with Hasson Needle

SAGES manual, volume 1, 3rd ed

TERIMA KASIH