THE LAPAROSCOPIC HARDWARE

The proper hardware and instruments are essential for performing a safe laparoscopy. Most large medical centers have one or several dedicated interventional laparoscopic operating rooms. Although not essential, it centralizes the hardware used for these procedures. This enables the nursing staff to become more familiar with the hardware and instruments used.

Several companies are now offering fully integrated laparoscopic operating rooms.

Using an electric or powered operating room table is a definite asset. In most cases, the surgeon has to frequently change the position of the patient in order to enhance exposure and visualization.

If performing laparoscopic bariatric procedures, the weight limit of the operating room table should be checked.

Computer-ready-connected operating table such as Hermes™ are a must if a surgical robot is used by the surgical team.

A Main and a Slave Monitor are used for most procedures. The usual size is 19 inches. Newer high resolution Flat Display panel are now being used with increasing frequency. Some of these newer monitor also have sterile touch function allowing the surgeon to command the entire laparoscopic video system via the flat monitor.

Additionally some medical centers are using "Head Mounted Display" with may enhance visualization during complex, advanced laparoscopic procedures. Vista Medical Technologies has introduced an integrated head mounted display with a 3D endoscope which has superb electronic interfaces with several laparoscopic systems.

The STORZ™ System and the Stryker™ System are the system we have used the most. Although we are still using earlier generations of their video camera, their latest generation of Video Camera (Three Chips and higher) has proven to be one of the best systems available. We are now also using a STRYKER Model 882TE system which appears to be a very competitive model. Most video systems have digital image enhancement features.

A 300-watt xenon light source is usually used. The light was transmitted via flexible, fiberoptic bundles connecting the light source to the telescope. The operator and the nursing staff should always be aware the light cords have a limited life span. When a significant decrease in light delivery is noted, the surgeon should verify the majority of the fiber optics are functional.

The CO2 pump should be a High Flow insufflation pump with a low flow and a high setting. This insufflator should be capable of delivering a maximum gas flow of CO2 of 9.9 L/min ( although some of them can deliver up to 20 L/min when connected to a trocar). These insufflators are electronically equipped to monitor, maintain and control a constant intra-abdominal pressure between 12 and 18 mm Hg. The inflow tubing is connected to the insufflation port of the machine and to a V connector that is attached to two different trocar insufflation ports for better and faster insufflation. A CO2 gas filter should be used between the pump and the trocar. Before every laparoscopy, the tubing system should be flushed with CO2 for at least one minute. Some insufflators are now equipped with CO2 tubing warmer; thus the delivered CO2 is warm (body temperature) which will in turn decrease "fogging" of the telescope.