Laparoscopic Instruments & Tower

5th PracticalDepartment of Surgical

Research and Techniques

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

5th PracticalDepartment 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 PracticalDepartment of Surgical

Research and Techniques

Difficulties of laparoscopic technique

Laparoscopic Tower

Diathermy controller (combined mono- and bipolar diathermy)

Monitor

Light source Camera control unit

Insufflator Suction-irrigation system

Video recorderRoller stand

5th PracticalDepartment of Surgical

Research and Techniques

Pneumoperitoneum

Lifting the abdominal wall by insufflation with carbon dioxide gas

Department of Surgical

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5th Practical

Veres needle

Connector to insufflation tubing

Sharp outer cannula

Spring-loaded inner stylet with a blunt tip

Inlet for gas

Proper handling position

5th PracticalDepartment 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-cylinder

Power switch

5th PracticalDepartment of Surgical

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Trocars

Outer diameter 2 mm -10 mmInner piercing stylus/ Shaft

Valve

Switch

Outer cannula/ Sleeve

5th PracticalDepartment of Surgical

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Safety Trocars

Corkscrew trocar Sharp and blunt shafts

Spring-loaded plastic shield

5th PracticalDepartment of Surgical

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Trocar Insertion

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

5th PracticalDepartment of Surgical

Research and Techniques

Light Source

Degree of brightness

Brightness adjustment Fibre-optic cablePower switch

5th PracticalDepartment of Surgical

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Check the light cable before use!

Telescopes

Traditional &

Hopkins Telescopes with rod

lens

optikai lencsék

quartz rúd-lencse

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

5th PracticalDepartment of Surgical

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Telescopes

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

The field of view can be changed by the rotation of the light cablein 30&40 degree telescopes

Camera

5th PracticalDepartment of Surgical

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Ocular (camera connection)

Camera Controller

Camera

Power switch

Camera plug in

5th PracticalDepartment of Surgical

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Telescope (bajonet) joint

Programing /White balance

Zoom ring

Focus ring

Cabel to the controller

Camera Head 5th PracticalDepartment of Surgical

Research and Techniques

Optical System

Light Source

Telescope

Camera

Camera Controller

Video Cable Video Recorder

Monitor

Surgical Team

5th PracticalDepartment of Surgical

Research and Techniques

Diathermy Controller 5th PracticalDepartment of Surgical

Research and Techniques

Double pedal footswitch

Mono- & Bipolar diathermy

Power switch

Bipolar diathermy forceps

Indifferent electrode pad

DiathermyDiathermy 5th PracticalDepartment of Surgical

Research and Techniques

Forceps head Forceps head

Insulation

++--

Monopolar

Hook

++

Bipolar

DiathermyDiathermy 5th PracticalDepartment of Surgical

Research and Techniques

Forceps head Forceps head

Insulation

++--

Monopolar

Hook

++

Bipolar

Insulated & Non-insulated handles

!

Suction(Hgmm)

Irrigation(Hgmm)

Sterile saline

Collector bottle for aspirated materials

Suction-Irrigation System

Hand piece/ Shaft

5th PracticalDepartment of Surgical

Research and Techniques

Suction-Irrigation SystemSuction-Irrigation System5th PracticalDepartment of Surgical

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Tubing

Multiple perforationThree-channel tube

5th PracticalDepartment of Surgical

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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 PracticalDepartment of Surgical

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Clip applier

Unifying Instruments

Staplers

5th PracticalDepartment of Surgical

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Suturing InstrumentsSuturing Instruments

Szabó-Berci needle holdersSzabó-Berci needle holders

Coaxial handle

Parrot-Jaw needle holder

Flamingo-Jaw assistant needle holder

5th PracticalDepartment of Surgical

Research and Techniques

Some pictures of this lecture are presented by

courtesy of Zoltán Szabó Ph.D.

5th PracticalDepartment of Surgical

Research and Techniques