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Laparoscopy instruments
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Laparoscopy Instruments

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Laparoscopy Instruments

  1. 1. Laparoscopy EquipmentS
  2. 2. Laparoscopy is a technologically dependent surgery.Laparoscopy is a technologically dependent surgery.  Computerized designing of laparoscopic instrumentsComputerized designing of laparoscopic instruments  Microprocessor controlled safety featuresMicroprocessor controlled safety features A laparoscopic surgeon should be technically well acknowledgedA laparoscopic surgeon should be technically well acknowledged ofof the principle of the instrumentthe principle of the instrument being usedbeing used, and should not always depend, and should not always depend upon their technical team should an emergency arrive.upon their technical team should an emergency arrive.
  3. 3. INSTRUMENTS/EQUIPMENTSINSTRUMENTS/EQUIPMENTS ExposureExposure VisualisationVisualisation ManipulationManipulation LaparotomyLaparotomy
  4. 4. Equipment cartEquipment cart
  5. 5. Insufflation systemsInsufflation systems  Insufflation system allows gas to fill the abdominopelvicInsufflation system allows gas to fill the abdominopelvic cavity to optimize visualization.cavity to optimize visualization.  Insufflators are designed to deliver gas at low rates duringInsufflators are designed to deliver gas at low rates during initial Veres needle insertion, but are also able to provide highinitial Veres needle insertion, but are also able to provide high flow rates when gas is lost to maintain a relatively constant setflow rates when gas is lost to maintain a relatively constant set intraabdominal pressure during surgery.intraabdominal pressure during surgery.  Insufflation tubing with a 0.3micron filter is recommended toInsufflation tubing with a 0.3micron filter is recommended to prevent intraperitoneal contamination with bacteria,prevent intraperitoneal contamination with bacteria, microparticles and debris from insufflator and gas tank.microparticles and debris from insufflator and gas tank.
  6. 6. Veress needleVeress needle  Spring loadedSpring loaded  Blunt tip retractable into sharp sheathBlunt tip retractable into sharp sheath  Small caliber penetrates tissues by separatingSmall caliber penetrates tissues by separating rather than cuttingrather than cutting  Disposable or reusableDisposable or reusable  Diameter 2mm and length 12-15cmDiameter 2mm and length 12-15cm  Insufflation upto 2.5L/minInsufflation upto 2.5L/min
  7. 7. Veress NeedleVeress Needle Veress needle : reusable / disposable
  8. 8. Veress needleVeress needle
  9. 9. Insufflation and abdominal liftingInsufflation and abdominal lifting systemssystems  Gases used for insufflationGases used for insufflation ::  Filtered room airFiltered room air  Carbon dioxideCarbon dioxide – commonly used , has advantage of being– commonly used , has advantage of being rapidly absorbed by blood, non toxic, cost effective and can berapidly absorbed by blood, non toxic, cost effective and can be used with cauteryused with cautery  Nitrous oxideNitrous oxide  HeliumHelium  Gasless laparoscopyGasless laparoscopy can be performed with the use of acan be performed with the use of a mechanical lifting arm that attaches to a fanlike retractor alongmechanical lifting arm that attaches to a fanlike retractor along the peritoneal surface of the abdominal wall . This approachthe peritoneal surface of the abdominal wall . This approach favoured in patients with cardiopulmonary risk factors.favoured in patients with cardiopulmonary risk factors.
  10. 10. InsufflatorsInsufflators 1966-Kurt Semm introduced the concept1966-Kurt Semm introduced the concept -Automatic-Automatic -Manual-Manual Indicators-Intra abdominal pressureIndicators-Intra abdominal pressure -Flow rate-Flow rate -Total gas used-Total gas used -Cylinder capacity-Cylinder capacity ThermoflatorThermoflator -Upto 20L/Min-Upto 20L/Min
  11. 11. Electronic EndoflatorElectronic Endoflator
  12. 12. Electronic ThermoflatorElectronic Thermoflator
  13. 13. Trocars and Cannulae/SleevesTrocars and Cannulae/Sleeves  Used to pierce the abdominal wall for placement ofUsed to pierce the abdominal wall for placement of laparoscope and surgical instrumentlaparoscope and surgical instrument  Available as disposable or reusable systemsAvailable as disposable or reusable systems  Trocar tips can be pyramidal, conical, blunt tipped, orTrocar tips can be pyramidal, conical, blunt tipped, or have optical accesshave optical access  Sizes vary from 3mm to 10mmSizes vary from 3mm to 10mm  Hassons trocar and cannulaeHassons trocar and cannulae  Expandable trocar sheaths are now availableExpandable trocar sheaths are now available
  14. 14. Endo Tip DeviceEndo Tip Device
  15. 15. Disposable trocharsDisposable trochars
  16. 16. IMAGING SYSTEMIMAGING SYSTEM Consists of :Consists of :  LaparoscopeLaparoscope  Camera unitCamera unit  Fiberoptic cordFiberoptic cord  Light sourceLight source  MonitorsMonitors
  17. 17. Laparoscope (Telescope)Laparoscope (Telescope)  British physicist Hopkins invented in 1952British physicist Hopkins invented in 1952  Conventional Thin lens System separated by airConventional Thin lens System separated by air  Present day scopes have series of rod lens in centre with rim of opticalPresent day scopes have series of rod lens in centre with rim of optical fibers on outer aspectfibers on outer aspect  Rod Hopkins System provides excellent field of vision with minimalRod Hopkins System provides excellent field of vision with minimal distortiondistortion END ON VIEW OUTER SHEATH LIGHT CONDUCTING FIBRES THE LENS CHAIN
  18. 18. TypesTypes  Based on size and angle of visionBased on size and angle of vision Size varies from 0.8 to 12mmSize varies from 0.8 to 12mm Routine use 10mm scopeRoutine use 10mm scope 5mm scope transmits 10% light of 10mm scope5mm scope transmits 10% light of 10mm scope 3mm scopes in paediatric practice3mm scopes in paediatric practice  Based on angleBased on angle 0 -Forward viewing0 -Forward viewing 30 -Angled30 -Angled 45 -Angled45 -Angled
  19. 19. Advantages of angled scopesAdvantages of angled scopes  Unobstructed view of dissecting area from distanceUnobstructed view of dissecting area from distance  More space for instrument maneuverabilityMore space for instrument maneuverability  Ability to look around the cornersAbility to look around the corners DisadvantagesDisadvantages  More difficult to operateMore difficult to operate Flexible and semi flexible scopesFlexible and semi flexible scopes  Fiber optic basedFiber optic based  Digital CCD camera basedDigital CCD camera based
  20. 20. Fogging of LensFogging of Lens  FoggingFogging :: due to increased temp. in abdomendue to increased temp. in abdomen  PreventedPrevented by dipping tip in warm water (atby dipping tip in warm water (at 6060ºCºC) & by touching liver / Abdominal Wall.) & by touching liver / Abdominal Wall.  Use of Antifog solutionsUse of Antifog solutions
  21. 21. The CameraThe Camera  Most important and vital partMost important and vital part  The sensor called CCD (Charged –Coupled Device) has smallThe sensor called CCD (Charged –Coupled Device) has small pieces of silicon called pixels, arranged in rows and columnspieces of silicon called pixels, arranged in rows and columns and are sensitive to lightand are sensitive to light  Single chipSingle chip Monitor resolution 400-450 linesMonitor resolution 400-450 lines  Three chipThree chip-----analog/ digital.-----analog/ digital. Light split into RGB spectrum by prism in head of camera.Light split into RGB spectrum by prism in head of camera. Analog=GB-700 to 750 lines—medical monitorAnalog=GB-700 to 750 lines—medical monitor Digital=Enhanced quality-1000 to 1200 lines like HDTVDigital=Enhanced quality-1000 to 1200 lines like HDTV
  22. 22.  White balancingWhite balancing  Zoom optionZoom option  Digital enhancementDigital enhancement Creates sharper image and contrastCreates sharper image and contrast enhancementenhancement Disadvantage is development of grainsDisadvantage is development of grains that distort quality of imagethat distort quality of image  Disadvantage of present day Cameras is 2D visionDisadvantage of present day Cameras is 2D vision Absence of depth perceptionAbsence of depth perception  3D Cameras3D Cameras Prohibitive costProhibitive cost No clear cut benefitNo clear cut benefit
  23. 23. HD Digital CameraHD Digital Camera
  24. 24. Light SourcesLight Sources Three typesThree types  HalideHalide  HalogenHalogen  XenonXenon Halogen-250 watt lampHalogen-250 watt lamp -Condenser system-Condenser system -built in spare lamp-built in spare lamp -Economical-Economical Xenon-175 or 300 watt lampXenon-175 or 300 watt lamp -500 hours life span-500 hours life span -Expensive-Expensive
  25. 25. Xenon Light SourceXenon Light Source
  26. 26. Light CablesLight Cables Two typesTwo types 1.Fluid filled cables1.Fluid filled cables 2.Fiber optic cables2.Fiber optic cables Fluid filled cableFluid filled cable -Conduct more heat-Conduct more heat -Stiffer nature-Stiffer nature -Causes hinderance in maneuvering angled scopes-Causes hinderance in maneuvering angled scopes -Inability to autoclave-Inability to autoclave Fiber opticFiber optic -More user friendly-More user friendly -Fragile to be handled with care-Fragile to be handled with care -Fiber damage of >25% to replace cable-Fiber damage of >25% to replace cable
  27. 27. LIGHT CABLESLIGHT CABLES  Fibreoptics - Multiple coaxial QuartzFibreoptics - Multiple coaxial Quartz Fibres,Fibres, transmit light bytransmit light by totaltotal internal reflectioninternal reflection..  Random or incoherent bundles transmitRandom or incoherent bundles transmit light.light.  Orientated or coherent bundles transmitOrientated or coherent bundles transmit an image.an image.  Filler material that binds the bundlesFiller material that binds the bundles absorbs the heat and there is 30% loss inabsorbs the heat and there is 30% loss in illuminosity ( "lux" )illuminosity ( "lux" )  New 'fluid light" cables without fillerNew 'fluid light" cables without filler material avoids this.material avoids this.
  28. 28. MonitorMonitor  Should support the resolution of the cameraShould support the resolution of the camera  Standard resolution monitors have a resolutionStandard resolution monitors have a resolution of 400 linesof 400 lines  High definition monitors-1200 linesHigh definition monitors-1200 lines
  29. 29. HD MonitorHD Monitor
  30. 30. Types of instrumentsTypes of instruments 1.Atraumatic forceps1.Atraumatic forceps 2.Grasping forceps2.Grasping forceps 3.Scissors3.Scissors 4.Bipolar forceps4.Bipolar forceps 5.Monopolar instruments5.Monopolar instruments 6.Retractors6.Retractors 7.Suction instrument7.Suction instrument 8.Needle holder8.Needle holder 9.Loop applicator9.Loop applicator 10.Clip applicator10.Clip applicator 11.Tackers11.Tackers 12.Endoanchors12.Endoanchors 13.Uterine Manipulators13.Uterine Manipulators
  31. 31. Hand InstrumentsHand Instruments Usually around 33cm longUsually around 33cm long Main partsMain parts -Handles-Handles -Shaft with insulation-Shaft with insulation -Inner effector part-Inner effector part Prerequisites for ideal Reusable instrumentsPrerequisites for ideal Reusable instruments 1.Jaws to be adequately elastic to perform atraumatic handling1.Jaws to be adequately elastic to perform atraumatic handling 2.Easy to disassemble and reassemble2.Easy to disassemble and reassemble 3.Parts should be interchangeable between similar instruments3.Parts should be interchangeable between similar instruments 4.Cleaning and sterilization to be easy4.Cleaning and sterilization to be easy 5.Simple design with minimum number of hinges and bolts5.Simple design with minimum number of hinges and bolts
  32. 32. OPERATING INSTRUMENTSOPERATING INSTRUMENTS Follow the general pattern of being “take apart”, withFollow the general pattern of being “take apart”, with  insulated sheaths,insulated sheaths,  central working device,central working device,  a handle with a ratchet,a handle with a ratchet,  with rotary capability at the working end.with rotary capability at the working end.
  33. 33. Hook ScissorHook Scissor
  34. 34. Endoretractor IEndoretractor I
  35. 35. Endoretractor II 10mmEndoretractor II 10mm
  36. 36. Needle HolderNeedle Holder
  37. 37. Myoma ScrewMyoma Screw
  38. 38. SURGICALINSTRUMENTATIONSURGICALINSTRUMENTATION
  39. 39. Clermont- FerrandClermont- Ferrand
  40. 40. Uterine ManipulatorUterine Manipulator
  41. 41. Vaginal tube and GrasperVaginal tube and Grasper
  42. 42. Energy and HemostasisEnergy and Hemostasis Electrosurgical UnitElectrosurgical Unit Vessel Sealing SystemVessel Sealing System
  43. 43. Harmonic ScalpelHarmonic Scalpel
  44. 44. LIGASURE – Vessel SealingLIGASURE – Vessel Sealing SystemSystem  Provides a combination of pressure and energy to create vessel fusionProvides a combination of pressure and energy to create vessel fusion  Permanently fuses vessels up to and including 7 mm in diameter and tissuePermanently fuses vessels up to and including 7 mm in diameter and tissue bundles without dissection or isolationbundles without dissection or isolation  Average seal cycle is 2 to 4 secondsAverage seal cycle is 2 to 4 seconds  Seals withstand three times normal systolic blood pressureSeals withstand three times normal systolic blood pressure  Feedback-controlled response system automatically discontinues energyFeedback-controlled response system automatically discontinues energy delivery when the seal cycle is complete, eliminating the guessworkdelivery when the seal cycle is complete, eliminating the guesswork
  45. 45. LIGASURELIGASURE
  46. 46. MORCELLATORMORCELLATOR
  47. 47. MorcellatorMorcellator
  48. 48. MorcellatorMorcellator
  49. 49. Myoma MorcellationMyoma Morcellation
  50. 50. Autosuture - ProtackAutosuture - Protack
  51. 51. Tackers being appliedTackers being applied
  52. 52. Cobbler NeedleCobbler Needle
  53. 53. Port Closure NeedlePort Closure Needle
  54. 54. Port ClosurePort Closure
  55. 55. Instruments for port closureInstruments for port closure (≥10mm)(≥10mm)
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