laparoscopic access + dissection devices
accessory
- dissecting balloon uses a distention balloon to separate tissues
- forms a discrete cavity for laparoscopic inguinal hernia repairs
camera
viewing
- projects images of an enclosed space when the camera head is connected to the eyepiece of an endoscope with light cord attached
- pass the plug end of the camera off the sterile field to be plugged into camera box
light cord
accessory
- tight bundle of fiber optic strands of glass that transmits light into an enclosed space when connected to endoscope
- broken fiber optics result from being crushed of coiled too tightly
laparoscope
viewing
- endoscope placed through a trocar sleeve into the abdomen to view organs
- the outer edge of the scope is surrounded by light fibers that pass through the light cord to illuminate the abdomen
veress needle
supply
- introduces CO2 gas into the abdomen to distend abdominal cavity allowing visibility
- inserted into the initial incision site and then attached to insufflation tubing
regular or long
insufflation tubing
supply
- this tubing is attached to a CO2 gas pump at one end, the other is attached to veress needle
- tubing has an inline filter to reduce contaminants that may enter the surgical site
trocar with sleeve
supply/ retractor/ viewing/ cutting
trocar: used to dissect through abd tissue to provide access to the abd cavity during endoscopic procedures
sleeve: provides a leak free seal that protects the skin and tissue layers from damage sustained while manipulating instruments
5+ 10 mm
blade, non blade, blunt, optical, obturator
trocar anchoring system
(grips, hasson anchors)
supply
- used in open technique when a blunt trochar with an anchor is inserted without the prior use of pneumoperitoneum through a small incision
- sutures placed on both sides of the sleeve and wrapped around the anchor to seal it
SILS port
(single incision laparoscopic surgery port)
supply
- flexible laparoscopic port that can accommodate up to three instruments
- used through a single incision
reducer cap
(toilet seat)
supply
- clips the top of a 12 mm or 10 mm trocar sleeve allowing 5 mm instruments to be used in larger ports
- prevents loosing pressure in the pneumonoperitoneum
micro scissors
cutting/ dissecting
- used to make very small cuts in fine structures
- such as the cystic duct
hook scissors
cutting/ dissecting
- hooked tie helps to keep slippery structures within the jaws of scissors while cut is made
- such slippery structures as ducts and vessels)
endoshear scissor
cutting/ dissecting
- most frequently used very sharp dissecting scissor
- used similarly as Metz scissors in an open case
5mm or 10mm
endo grasper
grasping/ holding
- traumatic: has wide jaw used to grasp and manipulate larger amounts of tissue
- comes in locking and non locking
bullet tipped grasper
grasping/ holding
- atraumatic: common grasper used on most tissue types
- it is named for its tip which is shaped like a bullet
maryland dissector
(dolphin dissector)
grasping/ holding/ dissecting
- atraumatic: used similarly as a debakey would be in an open case
- fine curved tip is used for blunt dissection of fatty or thin tissue
aggressive tooth grasper
(mother in law, gallbladder grasper)
grasping/ holding
- traumatic: used hold tissue that will be removed, be sure the surgeon is aware its got teeth
- commonly used to remove slippery gallbladder
5 mm or 10 mm
endoscopic allis clamp
grasping/ holding
- traumatic: used to firmly hold moderate strength tissue
- also for tissue that is being removed
endoscopic Babcock
grasping/ holding
- atraumatic: used for grasping fragile tissues
- just like the conventional Babcock clamp, it grasps bowel, appendix, stomach safely
Olson clamp
(cholangiogram clamp)
grasping/ holding
- atraumatic: used during laparoscopic cholecystectomy in conjunction with a catheter dye in syringe
- the catheter is loaded into the lumen of the handle of the clamp, then the syringe of dye is connected to the catheter
endoscopic biopsy punch
cutting
- traumatic: used to remove a bite of tissue
- sent as a specimen to pathology
blunt probe
retracting/ viewing/ probing
- atraumatic: used to manipulate tissues
- usually while exploring the abdomen and pelvis
needle aspirator
suctioning
- traumatic: this device is used to collapse fluid filled cysts or the gallbladder
- the leur lock end of the tube is attached to suction
suction bovie
suctioning/ occluding
- attached to suction at its leur lock end and to an electrical cord at the metal prong
- allows the surgeon to evacuate bovie smoke from the field as it is produced
