Laparoscopic Instruments & Tower

5th PracticeDepartment of Surgical

Research and Techniques

Requirements:1. Laparoscopic Tower – Parts and Functions 2. Usage of the Laparoscopic Instruments3. Practice on the Pelvitrainer

5th PracticeDepartment of Surgical

Research and Techniques

Laparoscopic Tower

Diathermy (mono- and bipolar diathermy)

Monitor

Light source Camera control unit

Insufflator Suction-irrigation system

Video recorderRoller stand

5th PracticeDepartment of Surgical

Research and Techniques

Pneumoperitoneum

Lifting the abdominal wall by insufflation with carbon dioxide gas

Department of Surgical

Research and Techniques

5th Practical

Veres needle

Connection ofinsufflator tube

Sharp outer cannula

Spring-loaded inner stylet with a blunt tip

Inlet for gas

Proper handling position

5th PracticeDepartment of Surgical

Research and Techniques

Insufflator

Intraabdominalpressure (mmHg)

Gas flow(liter/min)

Amount of the used gas (liter)

Antibacterial filter

Disposable insufflator tubing

Amount of gas in the gas-tank

Power switch

5th PracticeDepartment of Surgical

Research and Techniques

Trocars

Outer diameter 5 mm -10 mmInner cannula/ Sharp

Valve

Switch

Outer cannula is blunt/ Port

5th PracticeDepartment of Surgical

Research and Techniques

5th PracticeDepartment of Surgical

Research and Techniques

Safety Trocars

Corkscrew trocar Sharp and blunt shafts

Spring-loaded plastic shield

5th PracticeDepartment of Surgical

Research and Techniques

Trocar Insertion

The first trocar is inserted blindly, usage of safety trocars is mandatory!

5th PracticeDepartment of Surgical

Research and Techniques

Light Source

Degree of brightness

Brightness adjustment Fibre-optic cablePower switch

5th PracticeDepartment of Surgical

Research and Techniques

Check the light cable before use!

Telescopes

Traditional &

Hopkins Telescopes with rod lens and

fibers

optikai lencsék

quartz rúd-lencse

Length: 30 cmDiameter: 5 mm, 10 mmDegree: 0°, 30°, 45°

5th PracticeDepartment of Surgical

Research and Techniques

Telescopes

Objective lens (0° 30°45°)Light cable connection

The field of view can be changed by the rotation of the light cablein 30 and 44 degree telescopes

Camera

5th PracticeDepartment of Surgical

Research and Techniques

Ocular (camera connection)

Camera Controller

Camera

Power switch

Camera plug in

5th PracticeDepartment of Surgical

Research and Techniques

Telescope (bajonet) joint

Programing /White balance

Zoom ring

Focus ring

Cabel to the controller

Camera Head 5th PracticeDepartment of Surgical

Research and Techniques

Optical System

Light Source

Telescope

Camera

Camera Controller

Video Cable Video Recorder

Monitor

Surgical Team

5th PracticeDepartment of Surgical

Research and Techniques

Diathermy Controller 5th PracticeDepartment of Surgical

Research and Techniques

Double pedal footswitch

Mono- & Bipolar diathermy

Power switch

Bipolar diathermy forceps

Indifferent electrode pad

DiathermyDiathermy 5th PracticeDepartment of Surgical

Research and Techniques

Forceps head Forceps head

Insulation

++--

Monopolar

Hook

++

Bipolar

DiathermyDiathermy 5th PracticeDepartment of Surgical

Research and Techniques

Forceps head Forceps head

Insulation

++--

Monopolar

Hook

++

Bipolar

Insulated & Non-insulated handles

!

Suction(Hgmm)

Irrigation(Hgmm)

Sterile saline

Collected bottle for aspirated materials

Suction-Irrigation System

Hand piece/ Shaft

5th PracticeDepartment of Surgical

Research and Techniques

Suction-Irrigation SystemSuction-Irrigation System5th PracticeDepartment of Surgical

Research and Techniques

Tubing

Multiple perforationThree-channel tube

5th PracticeDepartment of Surgical

Research and Techniques

Dissectors & Grasping forceps

Biopsy forceps Ratchet

Pistol-grip handle

BabcockBowel Allis

Parts:handleouter tubeworking insert

Instruments II. II.

Metzenbaum scissors, Hook scissors, Biopsy forceps

5th PracticeDepartment of Surgical

Research and Techniques

Clip applier

Unifying Instruments

Staplers

5th PracticeDepartment of Surgical

Research and Techniques

Suturing InstrumentsSuturing Instruments

Szabó-Berci needle holdersSzabó-Berci needle holders

Coaxial handle

Parrot-Jaw needle holder

Flamingo-Jaw assistant needle holder

5th PracticeDepartment of Surgical

Research and Techniques

Some pictures of this lecture are presented by

courtesy of Zoltán Szabó Ph.D.

5th PracticeDepartment of Surgical

Research and Techniques

Two dimensional approach and three dimensional activity

Eye-hand coordination Feeling deepth Coordinate use of dominant and nondominant hand Lack of tactile sensation Magnifient surgical territory – finer manipulation Limitted movement Unusual instruments

Department of Surgical

Research and Techniques

5th PracticeDepartment of Surgical

Research and Techniques

Difficulties of laparoscopic technique