Maintenance of clear vision during laparoscopic surgery

Abstract

SummaryLaparoscopic surgeons will be familiar with the frustration generated by periodic interruptions to the operation caused by an impaired view through the laparoscope. If accidental bleeding occurs, a poor view of the operative field may threaten conversion to open surgery, or if severe, the patient's life. Maintenance of unimpeded visual clarity is therefore of prime importance during endoscopic surgery, but to date there has been little objective evidence documenting how this may be achieved. Investigations were conducted to identify conditions that hinder vision during endoscopic surgery, and some possible solutions were experimentally evaluated in inanimate and live animal models. It was concluded that to prevent the condensation of water vapour on the optical viewing surface an integrated, monitored electrical heating system is required. To maintain ideal visual conditions, insufflated gas should continuously flow directly over the front lens and be warmed and humidified. The optical system should also be capable of rinsing and drying the lens, and able to exsufflate smoke and particulate debris manufactured during electrocautery. This information was used in co-operation with an industry partner for the development of a multi-function optical system that provides continuously unencumbered acuity under all situations encountered in the laparoscopic environment.Key Words: laparoscopyendoscopytechnology-medical-instrumentation