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Laparoscopic Instruments

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Brandon Buckner, CST, CRCST
Lamar State College Port Arthur (TX)

Main Text

The origins of laparoscopic surgery trace back to the introduction of diagnostic laparoscopy in the 1960s. Subsequently, the approach underwent a notable evolution, transitioning from a primarily diagnostic procedure to a surgical technique. Laparoscopic surgery has become the gold standard for treating many pathologies such as symptomatic cholelithiasis, Crohn’s disease, and benign ovarian cysts.1,2,3 Laparoscopy, a type of minimally invasive surgery (MIS), was introduced to address issues related to significant tissue trauma, large cosmetic scars, and prolonged hospitalizations. Various studies have demonstrated that patients undergoing laparoscopic surgery have reduced risks of perioperative mortality and postoperative morbidity in comparison to individuals undergoing open surgery.4,5

In order to achieve safe and effective surgical outcomes, the operators are required to have an in-depth understanding of the basic and specialized equipment required. This video provides a step-by-step demonstration of the assembly, disassembly, use, and decontamination processes involved in handling laparoscopic tools on the example of a basic Karl Storz laparoscopy kit.

A set of requirements are established to guarantee the efficient handling of the instrument in both the sterilization unit and the operating room. Modern laparoscopic instruments have a distinctive design that enables complete disassembly of each instrument, facilitating efficient cleaning and decontamination. Every modular instrument undergoes validation to ensure that it can be sterilized while fully assembled.

The next part of the video explores three commonly used types of laparoscopic dissectors: the dolphin nose dissector, which has traditional micro-serrated tapered tips; the Maryland dissector with curved forceps, which is ideal for precise manipulations; and the laparoscopic right-angle dissector, which has cross-serrations on its angled tip for grasping tissues in hard-to-reach places. The assembly and disassembly of these dissectors are demonstrated, highlighting the importance of utilizing the tools with non-locking handles to allow for smooth surgeon maneuverability during procedures. The instruments must be completely opened, and the ratchet must be slid into position to activate the locking mechanism; a clear click is produced upon connection. Subsequently, the surgeon ensures proper functionality by opening and closing the instrument. When the surgeon uses their little finger to slide a specific piece down, the ratchet comes into operation. When closed, the ratchet facilitates a secure hold, maintaining the closed position until intentionally released. Moreover, the removal process involves opening the ratchet, pressing down on a designated button, and effortlessly sliding the handle off. The disassembly of the instrument is completed by twisting and separating the insert from the sheath. This modular design allows for convenient cleaning, maintenance, and potential replacement of individual components.

Next, the video provides a visual overview of medical graspers, which come in numerous variants, distinguished by the inner side of their jaws. Traumatic graspers feature deep serrations or toothed tips for secure gripping, ideal for rigorous procedures. On the other hand, atraumatic graspers have finely serrated inner jaws, providing a gentler touch suitable for delicate tasks involving fragile tissues. The importance of locking handles for graspers, particularly in situations requiring a secure grip, is visually underscored. 

A distinctive feature explored in the video is the integration of a Bovie, an electrosurgical device, with laparoscopic instruments. Viewers are visually guided through the steps of connecting the Bovie cord to the laparoscopic instrument handle, demonstrating the technique of efficient cauterization.

The sterilization of laparoscopic instruments is crucial, with procedures varying based on safety standards dictated by different countries. Before sterilization, these instruments undergo a meticulous process, including wiping down and spraying with enzymatic cleaner. An enzyme-based cleaner is an enzymatic detergent solution, penetrating the hard-to-reach parts of the equipment for thorough cleaning. This detergent offers distinct advantages, such as increased activity on proteins (like blood, feces, and mucous) through proteolytic enzymes, advanced formulations for quick and thorough penetration of organic matter, and a safe, biodegradable base that is gentle on both users and the environment. Following the cleaning process, items designated for disinfection must undergo a thorough rinse to remove any residual detergent. Subsequently, the instruments proceed to the final phase of sterilization.

This video is meant as an informative guide to laparoscopic instruments in the field of surgical technology. The step-by-step visual guidance through the assembly, use, and decontamination processes enhances the understanding of laparoscopic instruments.

Check out the complete series below:

  1. Scalpels
  2. Surgical Sutures
  3. Surgical Staplers
  4. Opening Sterile Surgical Packs
  5. Opening Sterile Surgical Instrument Containers
  6. Laparoscopic Instruments

Citations

  1. Ng A, Wang N, Tran M. Minimally invasive surgery: early concepts to gold standards. Br J Hosp Med. 2019;80(9). doi:10.12968/hmed.2019.80.9.494.
  2. Luglio G, Cricrì M, Tropeano FP, De Palma GD. Crohn’s disease: is minimally invasive surgery the gold standard? A narrative review. Ann Laparosc Endosc Surg. 2023;8. doi:10.21037/ales-22-75.
  3. Muzii L, Bianchi A, Crocè C, Manci N, Panici PB. Laparoscopic excision of ovarian cysts: Is the stripping technique a tissue-sparing procedure? Fertil Steril. 2002;77(3). doi:10.1016/S0015-0282(01)03203-4.
  4. Pan L, Tong C, Fu S, et al. Laparoscopic procedure is associated with lower morbidity for simultaneous resection of colorectal cancer and liver metastases: an updated meta-analysis. World J Surg Oncol. 2020;18(1). doi:10.1186/s12957-020-02018-z.
  5. Antoniou SA, Antoniou GA, Koch OO, Pointner R, Granderath FA. Meta-analysis of laparoscopic vs open cholecystectomy in elderly patients. World J Gastroenterol. 2014;20(46). doi:10.3748/wjg.v20.i46.17626.