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Handbook of Laparoscopy
Instruments
Edited by
Lamture Yeshwant Ramrao
Department of Surgery,
J.NMC, Wardha, India
Handbook of Laparoscopy Instruments
Editor: Lamture Yeshwant Ramrao
ISBN (Online): 978-981-5179-90-3
ISBN (Print): 978-981-5179-91-0
ISBN (Paperback): 978-981-5179-92-7
© 2023, Bentham Books imprint.
Published by Bentham Science Publishers Pte. Ltd. Singapore. All Rights Reserved.
First published in 2023.
BSP-EB-PRO-9789815179903-TP-108-TC-10-PD-20231229
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CONTENTS
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FOREWORD ........................................................................................................................................... i
PREFACE ................................................................................................................................................ ii
LIST OF CONTRIBUTORS .................................................................................................................. iii
CHAPTER 1 ERGONOMICS IN LAPAROSCOPY ........................................................................ 1
Meenakshi Yeola (Pate) and Sushanth R. Nayak
INTRODUCTION .......................................................................................................................... 1
What is Ergonomics? .............................................................................................................. 1
Ergonomics Significance ........................................................................................................ 2
The Hawthorne Effect ............................................................................................................. 2
Lack of Tactile Sensation ........................................................................................................ 2
The Reduced Degree of Freedom of Movement ..................................................................... 2
Decoupling of the Visual (Monitor) & Motor axis ................................................................. 3
Assuming A Relatively Stable Posture ................................................................................... 3
More Crowd ............................................................................................................................ 3
Dim-lit Room .......................................................................................................................... 4
Drawbacks for The Surgeon ................................................................................................... 4
Setbacks to The Patient ........................................................................................................... 5
Ideal Position .......................................................................................................................... 5
Reasons Hindering An Ideal Position ..................................................................................... 5
Operative Table Height ........................................................................................................... 5
Monitor Location .................................................................................................................... 5
Manipulation Angles for Instrumentation ..................................................................... 6
Triangulation ................................................................................................................. 6
Sectorisation .................................................................................................................. 7
EQUIPMENT RELATED CHALLENGES ................................................................................. 7
Limited View .......................................................................................................................... 7
Reduced Proficiency of The Instruments ................................................................................ 7
Shapes are Not Aptly Designed .............................................................................................. 8
Limited Instrument Mobility ................................................................................................... 8
Instrument Exchanges ............................................................................................................. 8
Intracorporeal Suturing ........................................................................................................... 8
Surgeon and Team Position .................................................................................................... 8
Recent Advances ..................................................................................................................... 8
One Port Laparoscopy ............................................................................................................. 8
Role of Robotic Surgery ......................................................................................................... 9
H.D. Monitors ......................................................................................................................... 9
3-D Laparoscopy ........................................................................................................... 9
Clinical Significance ............................................................................................................... 9
Solution ................................................................................................................................... 9
CONCLUSION ............................................................................................................................... 10
REFERENCES ............................................................................................................................... 10
CHAPTER 2 STERILIZATION .......................................................................................................... 13
Lamture Yeshwant Ramrao, Varsha P. Gajbhiye and Deepak Lamture
INTRODUCTION .......................................................................................................................... 13
Microbial Life and Sterilization .............................................................................................. 13
Steam Sterilization ........................................................................................................ 14
History of Autoclave ...................................................................................................... 14
Principle of Autoclave ................................................................................................... 15
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Mechanism .................................................................................................................... 15
High-Level Disinfection ................................................................................................ 16
Spaulding Classification of Medical Devices ............................................................... 16
CONCLUSION ............................................................................................................................... 17
REFERENCES ............................................................................................................................... 17
CHAPTER 3 OPERATION THEATRE LAYOUT, EQUIPMENT SETUP AND
TROUBLESHOOTING .......................................................................................................................... 18
Harshal Ramteke, Rohini Bhoyar, Ashirwad Sankhe and Lamture Yeshwant Ramrao
INTRODUCTION .......................................................................................................................... 18
OPERATING THEATRE LAYOUT AND EQUIPMENT POSITION [4] .............................. 18
General Considerations ........................................................................................................... 18
Establishing the Orientation and Appropriate Position of the Operating Table ..................... 19
Optimal Position and Orientation of the Surgical Team ......................................................... 19
Robotic System and Its Effect on Operating Theatre Space ................................................... 19
Checklist for Equipments [3, 4] .............................................................................................. 22
SETUP OF THE OPERATING ROOM AND EQUIPMENT [3, 4] ......................................... 23
TROUBLESHOOTING [3, 5] ....................................................................................................... 25
OPERATING ROOM FIRES [4, 6] .............................................................................................. 25
CONCLUSION ............................................................................................................................... 28
REFERENCES ............................................................................................................................... 28
CHAPTER 4 OPTICAL DEVICES ..................................................................................................... 29
Venkatesh Rewale, Aditya Patel and Lamture Yeshwant Ramrao
INTRODUCTION .......................................................................................................................... 29
Imaging System ...................................................................................................................... 30
Laparoscopes ................................................................................................................ 30
Light Source .................................................................................................................. 30
Light Cable .................................................................................................................... 33
Cameras ........................................................................................................................ 35
Television Monitor With Instrument Trolley ................................................................. 36
CONCLUSION ............................................................................................................................... 38
REFERENCES ............................................................................................................................... 38
CHAPTER 5 EQUIPMENT FOR CREATING AND MAINTAINING THE
PNEUMOPERITONEUM ...................................................................................................................... 39
Sanjeev Gianchandani, Resha Keshwani, Sachin Gianchandani and Lamture Yeshwant
Ramrao
INTRODUCTION .......................................................................................................................... 39
Insufflator ................................................................................................................................ 39
Lapro-Manometers .................................................................................................................. 40
Pulsatile Flow and Plane of Surgery ....................................................................................... 42
Gas for Pneumoperitoneum .................................................................................................... 42
Carbon Dioxide ....................................................................................................................... 42
Suction Irrigation Machine ..................................................................................................... 44
CONCLUSION ............................................................................................................................... 46
ACKNOWLEDGEMENTS ........................................................................................................... 47
REFERENCES ............................................................................................................................... 47
CHAPTER 6 INSTRUMENTS FOR ACCESS .................................................................................. 50
Deepak Lamture, Lamture Yeshwant Ramrao and Varsha P. Gajbhiye
INTRODUCTION .......................................................................................................................... 50
Veress Needle ......................................................................................................................... 50
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Hassan Cannula ....................................................................................................................... 51
Optical Trocar ......................................................................................................................... 52
Trocars .................................................................................................................................... 52
CONCLUSION ............................................................................................................................... 54
REFERENCES ............................................................................................................................... 54
CHAPTER 7 HAND INSTRUMENTS ............................................................................................... 56
Tushar Nagtode, Rajesh Domakunti and Lamture Yeshwant Ramrao
INTRODUCTION .......................................................................................................................... 56
Operative Hand Instruments ................................................................................................... 57
Handles ......................................................................................................................... 58
Insulated Outer Tube ..................................................................................................... 58
Reducing Sleeve ............................................................................................................ 58
Graspers .................................................................................................................................. 59
Traumatic Grasping Forceps ........................................................................................ 59
Atraumatic Grasping Forceps ....................................................................................... 59
Dissectors ................................................................................................................................ 63
Maryland Dissector ....................................................................................................... 63
Bipolar Dissector Fig. (7.10) ........................................................................................ 63
Instruments for Sharp Dissection ............................................................................................ 64
Scissors .......................................................................................................................... 64
Bowel and Lung Clamp ................................................................................................. 65
Needle Holders .............................................................................................................. 65
Coagulation Instruments ......................................................................................................... 66
Hook and Spatula .......................................................................................................... 66
Suture Passer Devices ............................................................................................................. 67
Vaginal Probe ............................................................................................................... 68
Irrigation-suction .......................................................................................................... 69
CONCLUSION ............................................................................................................................... 70
REFERENCES ............................................................................................................................... 70
CHAPTER 8 ENERGY DEVICES: WORKING PRINCIPLES, USES AND COMPLICATIONS 71
Raju Kamlakarrao Shinde, Sangita Devrao Jogdand and Lamture Yeshwant Ramrao
INTRODUCTION .......................................................................................................................... 71
ELECTROSURGERY PARTS ..................................................................................................... 75
MONOPOLAR ELECTROSURGERY ....................................................................................... 75
Adaptive Technology in the Active Electrode ........................................................................ 76
Returning Electrode Monitoring System ................................................................................ 76
Complications ......................................................................................................................... 77
Direct Coupling ............................................................................................................. 77
Insulation Failure .......................................................................................................... 77
Capacitive Coupling ...................................................................................................... 78
Advantages .................................................................................................................... 78
Disadvantages ............................................................................................................... 78
Specialized Electrosurgical Units ........................................................................................... 79
Harmonic Scalpel .......................................................................................................... 79
Advantages .................................................................................................................... 79
Disadvantages ............................................................................................................... 80
Vessel Sealing Bipolar Electrosurgery [Ligasure] .................................................................. 80
Advantages .................................................................................................................... 80
Disadvantages ............................................................................................................... 81
Argon Plasma Coagulation ..................................................................................................... 81
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Advantages .................................................................................................................... 81
Disadvantages ............................................................................................................... 82
Cavitron Ultrasonic Surgical Aspirator [C.U.S.A.] ................................................................ 82
Advantages .................................................................................................................... 84
Disadvantages ............................................................................................................... 84
Laser Electrosurgery ............................................................................................................... 84
Types of Lasers ....................................................................................................................... 85
Advantages .................................................................................................................... 85
Disadvantages ............................................................................................................... 85
Radiofrequency Energy .......................................................................................................... 85
CONCLUSION ............................................................................................................................... 87
REFERENCES ............................................................................................................................... 88
CHAPTER 9 BASIC ENDOSCOPIC ACCESSORIES .................................................................... 89
Parmeshwar Ramesh Junare and Vijendra Kirnake
INTRODUCTION .......................................................................................................................... 90
Common Endoscopic Accessories .......................................................................................... 90
Hemostatic Devices ....................................................................................................... 90
Injection Needles ........................................................................................................... 91
Hemoclips ...................................................................................................................... 92
Thermocoagulation Devices .......................................................................................... 93
Argon Plasma Coagulation (APC) ................................................................................ 95
Endoscopic Band Ligation (EBL) ........................................................................................... 96
Glue ......................................................................................................................................... 97
Foreign Body Retrieval Devices ............................................................................................. 97
Biopsy Forceps ........................................................................................................................ 97
Dilators .................................................................................................................................... 98
Balloon Dilators ............................................................................................................ 98
Achalasia Balloon Dilators ........................................................................................... 99
Feeding Tubes ......................................................................................................................... 99
CONCLUSION ............................................................................................................................... 100
REFERENCES ............................................................................................................................... 100
CHAPTER 10 ROBOTIC SURGERY ................................................................................................ 102
Varsha P. Gajbhiye, Deepak Lamture and Lamture Yeshwant Ramrao
INTRODUCTION .......................................................................................................................... 102
Advantages of Robotic Surgery .............................................................................................. 103
CONCLUSION ............................................................................................................................... 103
REFERENCES ............................................................................................................................... 104
SUBJECT INDEX
....................................................................................................................................
105
FOREWORD
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I am pleased to know the “Handbook of Laparoscopy Instrument” will be published under the
inspiring leadership of Dr. Y. R. Lamture Professor, Department of Surgery, Jawaharlal
Nehru Medical College (constituent unit of Datta Meghe Institute of Medical Sciences
(deemed to be university). Sawangi (Meghe) Wardha. I also present my appreciation to the
team of faculty members for their support to him in this successful publication.
I compliment Dr. Y. R. Lamture and his team for their hard work and earnest efforts for the
successful publication of this book. The purpose of this book is to help students develop deep
insights into the subjects and build their concepts from the beginning. I hope this Handbook
reaches all the students and becomes a popular tool amongst them.
I again congratulate Dr. Y. R. Lamture who led this entire worthwhile exercise in a
meticulous and insightful manner.
Dr. Lalitbhushan Waghmare
Vice Chancellor
Datta Meghe Institute of Higher Education and Research (Deemed to be University)
India
i
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