Laparoscopes lengths
Length: 30-45cm
Diameter: 2-10mm
What are the degrees for scopes?
0 degree: best for small area in direct line with scope and working ports (ex. deep in pelvis or high in mediastinum), some have flexible tip
30 or 45 degree: offers more versatility
Hopkins Rodland system
a way to transmit light from source to operative field and capture reflected light and transfer back to camera
- light decreases as scope lengthens, diameter decreases, or angle increases
- damage can occur as length increases or diameter decreases
What do newer devices use instead of Hopkins Roland system?
- chip is at the end of the scope so it doesn’t have to go back
- a flexible tip, brighter image, high definition capture chips
What set up do you need for laproscopic surgery?
- equipment needed to open and close ports sites
- standard open surgical equipment in case you need to open
What do you do if you image is dark or blurry?
- check fiberoptic by holding lends up to light and looking into light cord attachment –> black spots present if fibers are damaged
- look at lens for obvious damage
- look if moisture in eye piece between cope and camera –> fix by drying with a gauze
How do you defog the lens?
- Fred: chemical agent, let dry for a few seconds before reinsertion
- can keep in hot water/bath or insulated bottle
How do you clean smudged lens?
wiping scope on clean tissue, removing scope and cleaning with hot/water gauze pad, and clean mechanical seal/port
What gas is used in laparoscopy?
CO2: inexpensive, does not support combustion
- always need new tank with wrench in room
- or use a central CO2 line
What is use of warmed/humified CO2 associated with?
differences in pt body temp and post op pain –> not clinically significant (es if surgery <90min)
what is the insulator system?
controls flow of gas from COO2 to abdomen
What is high flow?
10+L/min
what does the insufflations system show?
pressure preset, gas flow preset, amount of gas used, current abdominal pressure
What is the sterile gas line with filter?
- filter stops pt products going between patients
- attached with lure lock or push on tube
What three suction devices are needed?
Anesthetist, NG, operative field
- can lead to decreased CO2, so fully immerse suction catheter in fluid to prevent loss of pneumo
what are the components of the video tower?
light source: 300 watt Xenon lamp (light cables: check quality of cable by holding up to light and looking for black dots)
camera control unit
video monitor
insufflator
what type of monitor is needed for high def camera?
ideally one that can display high def images
what is Picture in Picture?
displays an image in corner with the laparoscopic image still up (ex. US if intraop US is needed)
- useful for hysterooscopy, liver US/bx, common bile duct exploration
what might the CO2 gauge read if connected to central CO2 supply?
empty
trouble shooting steps
- check co2 tank is attached and full, gasket isn’t damaged and spare gasket/tank is available
- all cables are correctly and securely connected
- all equipment needed is present
what is role of circulator?
- monitor co2 level
- monitor insufflator settings
- monitor energy source, check cables, assist monitor positioning, assist with photo documentation
how to trouble shoot loss of working space?
- check insufflator display
actual pressure>set pressure:
Flow rate=0, check actual and set pressures of pneumo
-pt may not be relaxed enough (check status os muscle relaxation)
- may be mechanical blockage in tube or at valve port (check valve on port connected to insufflator tubing and tubing along its path)
actual pressure<set pressure:
flow rate=high
- check if tubing disconnected from insufflator or port
- check ports for leaking around insertion site or through mechanical seal, check port sites for leaking coo2
- check if dissension into bowel or bladder (is co2 going there?)
