(About Laparoscopic Instruments)
Instrument usage: Laparoscopic instruments are inserted through a small, minimally invasive incision.1 Laparoscopes are rigid and allow for viewing a body cavity and come in many sizes and angles. Laparoscopic instruments include instrumentation, which may be disposable or reusable, and needles and trocars, forceps, graspers and scissors, clip appliers and stapling devices, needle holders, aspiration-irrigation systems.2
Key differences:
Verres needles and trocars, both sharp and blunt, are used to provide access and insufflation to create a working space.2 They come in different sizes and connect to CO2 tubing that allows the gas to flow at 1L to 2L per minute to create an intraperitoneal pressure of approximately 15 mmHg for the average adult.1 For other body cavities, such as a joint or the bladder, fluid can use fluid to create working space.
Laparoscopes with cords come in multiple sizes that can attach to a camera to take photos and videos, and allow the surgical team view the procedure.1 The angle of the laparoscope used, which can be 0 degree, 30 degree, 45 degree or 70 degree, is determined by the field of view that is required for the surgical procedure.
There are a variety of forceps, graspers, and scissors with different types of tips and sizes and some that can cauterize and control bleeding. 2 The tips can be duckbill (flat and straight), dolphin (pointed and straight), Babcock (tubular), or Maryland (curved), but they all have a ringed handle that can be locking or nonlocking.1 The surface of the jaws can be smooth, serrated, or toothed and the jaws can rotate or be fixed.1
Clip appliers, stapling devices, and needle holders are most often disposable and the cutting instruments usually require a larger port of entry such as a 12mm trocar.1 Suturing instruments use a fixed instrument and a mobile jaw, that moves the needle back and forth through the tissue, with a knot pusher that slides the knot into place. 1 This is called extracorporeal knot tying.
Aspiration-irrigation systems are tubular instruments that irrigate and aspirate fluid. They can have a blunt tip or needlepoint tip.
Safety on the sterile field:
Needles and trocars on the sterile field should be handled as sharp instrumentation.
Scopes should be examined prior to use to be certain that the visibility is appropriate and that the light cord fits correctly.
It is important to wipe the tips of the forceps, graspers, and scissors between uses with a wet sponge to remove any debris.
CO2 should be warm. If it is cold, it can cause fogging. A cold scope entering the body cavity can also cause fogging.1 A scope warmer and anti-fog solution should be used on the sterile field.
Scrub personnel must look at the sheath of the forceps, graspers, and scissors to be certain that there is no break in continuity. A pinpoint hole can cause a patient burn.
Direct coupling can occur if a metal instrument accidentally contacts the abdominal wall; therefore, the surgeon should avoid activating the instrument when not in touch with tissue.1
Instrument names:
Instruments are called by their use, such as “trocar” or “scope” or “grasper.” If there are multiple sizes or tips, the surgeon will preface the size or type of tip before the name, such as “10 mm trocar,” “5mm scope,” or “Maryland grasper.”
References:
1. Phillips, Nancymarie. Berry & Kohn's operating room technique. Elsevier Health Sciences, 2016.
2. Rothrock, Jane C. Alexander's Care of the Patient in Surgery-E-Book. Elsevier Health Sciences, 2018.