Konstantinos I Makris, MD, Andrew S Kastenmeier, MD, Christy M Dunst, MD, Mark H Whiteford, MD. The Oregon Clinic
Background: The safety and effectiveness of laparoscopic surgery relies on the clarity of the image provided by the rod-lens system and the chip camera. Clear vision ensures precision, uninterrupted flow of the surgical movements and promotes efficient surgical team function. Technological advances have improved the quality of the optic equipment used, with improved lenses, better cameras, high-definition monitors and stronger illumination now being available.
Despite these advances, laparoscopy is still plagued by obscured lenses as a result of fogging, intraabdominal bleeding, contact with the patient’s tissues or soiling during the passage of the laparoscope through the ports. Lens warmers, anti-fog lens cleaners, insufflation gas humidifiers have been used with moderate success. The usual maneuver of removing the laparoscope, cleaning the lens, applying anti-fog coating and reinsertion in the abdomen is repeatedly performed during most laparoscopic cases, it adds to the duration of the case, it increases the frustration of the operating surgeon and disturbs the flow of the surgical team function.
Objective of the device: To utilize a commercially available, reusable, lens irrigation system, which allows intraabdominal cleansing of the laparoscope lens. This device leads to easier maintenance of clear view, less withdrawals of the laparoscope outside the abdomen and reduction of the frustration level in the operating team.
Description of the technology and method of its use: A metallic overtube, equipped with a leur lock side port allowing irrigation and suctioning through it with a standard 10 ml syringe, is slid over the 10-mm, 25-degree laparoscope. Irrigation removes foreign particles from the lens and eliminates fogging condensation.
In the absence of dedicated lens irrigation overtubes, we have been using components of the commercially available transanal endoscopic microsurgery (TEM) system. Specifically, we have used the TEM laparoscope along with the metallic overtube. The device can be inserted though a 12-mm trocar (picture).
Preliminary results: This device has been used exclusively for our TEMS cases for over 10 years. This past year, we began using it for advanved laparoscopic procedures. Our initial experience reveals an extreme improvement in our visualization in laparoscopic cases. The need to remove the laparoscope outside the abdomen for cleansing has almost been eliminated. No compromises in the quality of visualization are made, since irrigation is easy and rapid. The cleaning process never becomes the focus of attention during the procedures and this allows uninterrupted, well-coordinated function of the surgical team.
Conclusions/ Future directions: The use of the irrigation overtube provides easy and rapid cleansing of the lens intraabdominally in minimally invasive surgery. This constitutes a re-emerging technology that provides a simple solution to a common problem, which persists in an era of complex technological advances. Validation of our experience with a prospective comparative study is planned. The development of irrigation overtubes that fit on all the commonly used laparoscopes appears to be the next step, which will allow widespread use of this method.
Session: Emerging Technology Poster
Program Number: ETP041