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Endoscopic Accessories Handbook of Laparoscopy Instruments 99
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Achalasia Balloon Dilators
Specifically designed for achalasia cardiac pneumatic balloon dilatations. It is
avalable in three diameters (30, 35 and 40 mm). These balloons do not pass
through the endoscope working channel. The balloon is passed over the guidewire and is positioned across the gastroesophageal junction using fluoroscopy
aided radio-opaque markers on balloon. Air is used for balloon insufflation which
is monitored manometrically [10] (Fig. 7).
Fig. (7). Achalasia balloon dilators.
Feeding Tubes
Feeding tubes provide GI tract access for short-term or long-term enteral
nutrition. Apart from enteral nutrition, they also help in decompression of the
100 Handbook of Laparoscopy Instruments Junare and Kirnake
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obstructed GI tract in surgical non-candidacy subject and patients with refractory
gastroparesis. Feeding tubes are commonly made of polyurethane. Some tubes
may be of silicone. Diameters range from 3.5F to 16F length of 15 to 170 cm.
Placement may be carried out unassisted at the bedside or under endoscopic or
fluoroscopic guidance. Stylets or guidewire within feeding tubes aid in their
placement. Double-lumen and triple-lumen feeding tubes which allow access to
both stomach and intestines are also available. There are various methods of
endoscopic placement including placement over the guidewire into small
intestines, drag and pull method with the final oronasal transfer tube, and
transnasal endoscopic placement using an ultrathin endoscope, eliminating need
of oronasal transfer tube [11].
Fig. (8). Feeding tubes.
CONCLUSION
In summary, this chapter has given us a thorough understanding of the history of
endoscope technology and an excellent overview of different types of scopes and
their accessories. It has also provided a detailed exploration of critical tools like
biopsy forceps, dilators, ERCP accessories, hemostatic devices, and feeding tubes,
highlighting their applications and advantages. Moreover, the chapter sheds light
on recent advances in endoscope technology, which hold the potential to
transform medical procedures and enhance patient outcomes. This knowledge is
crucial for healthcare professionals and medical students alike to keep up-to-date
with the latest developments in medical technology.
REFERENCES
[1] ASGE technology committee. Devices for endoscopic hemostasis of nonvariceal GI bleeding (with
videos).VideoGIE 2019; 4(7): 285-99.
[http://dx.doi.org/10.1016/j.vgie.2019.02.004]
[2] Jacques J, Legros R, Chaussade S, Sautereau D. Endoscopic haemostasis: An overview of procedures
and clinical scenarios. Dig Liver Dis 2014; 46(9): 766-76.
[http://dx.doi.org/10.1016/j.dld.2014.05.008] [PMID: 25022337]
Endoscopic Accessories Handbook of Laparoscopy Instruments 101
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[3] Romagnuolo J. Endoscopic clips: past, present and future. Can J Gastroenterol 2009; 23(3): 158-60.
[http://dx.doi.org/10.1155/2009/515937] [PMID: 19319378]
[4] Zippi M, Traversa G, Cocco A, et al. Utilizzo della coagulazione con argon plasma in endoscopia
digestiva: revisione della letteratura. Clin Ter 2012; 163(6): e435-40.
[PMID: 23306759]
[5] Cordon JP, Froilan Torres C, Burgos García A, Gea Rodriguez F, Suárez de Parga JM. Endoscopic
management of esophageal varices. World J Gastrointest Endosc 2012; 4(7): 312-22.
[http://dx.doi.org/10.4253/wjge.v4.i7.312] [PMID: 22816012]
[6] Al-Hillawi L, Wong T, Tritto G, Berry PA. Pitfalls in histoacryl glue injection therapy for
oesophageal, gastric and ectopic varices: A review. World J Gastrointest Surg 2016; 8(11): 729-34.
[http://dx.doi.org/10.4240/wjgs.v8.i11.729] [PMID: 27933134]
[7] Sugawa C, Ono H, Taleb M, Lucas CE. Endoscopic management of foreign bodies in the upper
gastrointestinal tract: A review. World J Gastrointest Endosc 2014; 6(10): 475-81.
[http://dx.doi.org/10.4253/wjge.v6.i10.475] [PMID: 25324918]
[8] Barkun A, Liu J, Carpenter S, et al. Update on endoscopic tissue sampling devices. Gastrointest
Endosc 2006; 63(6): 741-5.
[http://dx.doi.org/10.1016/j.gie.2006.02.041] [PMID: 16650530]
[9] Siddiqui UD, Banerjee S, Barth B, et al. Tools for endoscopic stricture dilation. Gastrointest Endosc
2013; 78(3): 391-404.
[http://dx.doi.org/10.1016/j.gie.2013.04.170] [PMID: 23948186]
[10] van Hoeij FB, Prins LI, Smout AJPM, Bredenoord AJ. Efficacy and safety of pneumatic dilation in
achalasia: A systematic review and meta-analysis. Neurogastroenterol Motil 2019; 31(7): e13548.
[http://dx.doi.org/10.1111/nmo.13548] [PMID: 30697952]
[11] Kwon RS, Banerjee S, Desilets D, et al. Enteral nutrition access devices. Gastrointest Endosc 2010;
72(2): 236-48.
[http://dx.doi.org/10.1016/j.gie.2010.02.008] [PMID: 20541746]
102 Handbook of Laparoscopy Instruments, 2023, 102-104
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CHAPTER 10
Robotic Surgery
Varsha P. Gajbhiye1, Deepak Lamture1 and Lamture Yeshwant Ramrao
1
Department of Surgery, J.NMC, Wardha, India
Abstract: Primarily, it is a computer-assisted surgery. It's a modified future of
minimally invasive surgery. With this method, the surgeon makes decisions and gives
commands, and a robot carries out the surgery. The main advantage of robotic or
minimally invasive surgery is that instead of operating patients through large incisions,
patients get operated on through small incisions with less trauma to the tissue. There is
less pain and a shorter hospital stay with an early return to work.
1,*
Keywords: Console, 3-D view, -Da Vinci system, Robot, Simulation, ZEUS.
INTRODUCTION
primarily, it is a computer-assisted robotic surgery. It's a modified future of
minimally invasive surgery. With this method, the surgeon makes decisions and
gives commands, and a robot carries out the surgery. The main advantage of
robotic or minimally invasive surgery is that instead of operating patients through
large incisions, patients get operated on small incisions with less trauma to the
tissue. There is less pain and a shorter hospital stay with a sooner return to work.
Most commonly used surgical robot is “Da Vinci system” (Fig. 1). It consists of a
surgical console, a patient-side cart and instruments, and imaging processing
equipment [1]. The surgeon controls the instruments and the camera from a
console located in the operating room. Placing his fingers into the master controls,
he can operate all four arms of the Da Vinci simultaneously while looking through
a stereoscopic high-definition monitor that places him inside the patient, giving
him a better and a more detailed 3-D view of the operating site more than the
human eye. The robot system is very costly, costing around 12-20 crores (in
Indian rupees).
ZEUS [2] was the first surgical robot to perform surgery when it was used in 1997
to reconnect fallopian tubes in the state-of-the-art robotic surgery in Cleveland,
*
Corresponding author Lamture Yeshwant Ramrao: Department of Surgery, J.NMC Wardha; India;
E-mail:yash18671@gmail.com
All rights reserved-© 2023 Bentham Science Publishers
Lamture Yeshwant Ramrao (Ed.)
Robotic Surgery Handbook of Laparoscopy Instruments 103
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Ohio, USA.The company that developed the ZEUS robot was purchased by
Intuitive Surgical, Inc., and after years of attempts to upgrade the system, they
brought out the da Vinci surgical robot. In 2005, the US Food and Drug
Administration (FDA) approved the use of the da Vinci robotic system in
gynecological surgery. A recent report by Intuitive Surgical, Inc. pointed out that
during 2007–2013, the number of robotic surgical systems were doubled in the
US (from 800 to 2001) and Europe (from 200 to 443). The same report stated that
1.5 million robotic surgeries had been performed until 2013 in the world [3].
Advantages of Robotic Surgery
●
Surgeon controls movements of sophisticated instruments using console.
●
Complex procedures done with ease, stability, accuracy.
●
Better reach to deep areas, less conversion to open.
●
Minimal blood loss.
●
Quicker recovery, less hospital stay, minimal need for antibiotics.
●
For patient –less pain, no scar, normal activity [4].
Fig. (1). Diagrammatic presentation of robotic surgery.
CONCLUSION
As compared to open and laparoscopic methods of surgical approach, the learning
curve of robotic surgery is in its niche. However, the chances of robotic systems
replacing laparoscopic systems are very high in the near future in view of
104 Handbook of Laparoscopy Instruments Gajbhiye et al.
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advancing surgical technology and bringing surgery into the digital age. Major
concerns in robotic surgery are the cost and long learning curve. Hence further
research to evaluate a true benefit over conventional therapy for robotic surgery to
take full root.
REFERENCES
[1] Spaner SJ, Warnock GL. A brief history of endoscopy, laparoscopy, and laparoscopic surgery. J
Laparoendosc Adv Surg Tech A 1997; 7(6): 369-73.
[http://dx.doi.org/10.1089/lap.1997.7.369] [PMID: 9449087]
[2] Gutierrez M, Ditto R, Roy S. Systematic review of operative outcomes of robotic surgical procedures
performed with endoscopic linear staplers or robotic staplers. J Robot Surg 2019; 13(1): 9-21.
[http://dx.doi.org/10.1007/s11701-018-0822-5] [PMID: 29744808]
[3] Sheetz KH, Claflin J, Dimick JB. Trends in the adoption of robotic surgery for common surgical
procedures. JAMA Netw Open 2020; 3(1): e1918911.
[http://dx.doi.org/10.1001/jamanetworkopen.2019.18911]
[4] Singh H, Modi HN, Ranjan S, et al. Robotic Surgery Improves Technical Performance and Enhances
Prefrontal Activation During High Temporal Demand. Ann Biomed Eng 2018; 46(10): 1621-36.
[http://dx.doi.org/10.1007/s10439-018-2049-z] [PMID: 29869104]
Handbook of Laparoscopy Instruments, 2023, 105-108 105
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SUBJECT INDEX
A
Ablation 86, 87
desired 86
effective tumour 87
tumor volume 87
Achalasia cardia 89, 92
Acid 3, 9, 14, 16
lactic 3, 9
peracetic 14, 16
Active electrode 72, 75, 76, 77, 78, 83, 87
insulated 78
Active electrode monitoring systems 78
Acute angle twisting 33
Adhesiolysis 64
Air 42, 81, 99
displaces 81
embolism 42
Anaesthesia 18
Appendicectomy 7
Argon 71, 81, 82, 89, 94, 95, 96
enhanced electrosurgery 71
gas 71, 82
plasma coagulation (APC) 81, 89, 94, 95,
96
Art of laparoscopic surgery 27
Atraumatic 59
forceps 59
grasping forceps 59
B
Balloon dilators, achalasia 99
Binocular effect 3
Biopsy forceps 89, 90, 97, 98, 100
Bipolar 63, 76
cord 63
electrosurgery 76
Blade 79, 80
vibrating 79
fatigue 80
Bleeding vessel site 94
Blood vessels 84
Lamture Yeshwant Ramrao (Ed.)
All rights reserved-© 2023 Bentham Science Publishers
Botulinum toxin 92
Breast augmentation 42
Burning eyes 9
C
Cables 22, 33
fibre-optic 22
fluid-filled 33
liquid crystal gel 33
Cardiac pacemakers 76, 78
Carpal tunnel syndrome 5
Cellular 79, 84
debris 84
friction 79
Cervical spondylitis 9
Chemical sterilizers 30
Cholangiography 22
Coagulation 56, 66, 69, 70, 71, 73, 75, 79, 80,
81, 85, 94, 95
devices 56, 70
effective 95
pathway 94
Coagulator Ball-tipped coagulator 23
Collision dangers, creating 4
Combination suction/irrigation devices 69
Compression, mechanical 96
Condensing lenses 33
Configuration, ergonomic 6
Console, surgical 102
Contact coagulation devices 94
Container, hot metallic 14
Contaminated instruments 13
Cosmetic plastic surgery 85
Crocodile grasper 56, 61
Cyanoacrylate 92
Cystic capsule 59
Cytochemical reaction 91
D
Da Vinci system 102
Damage 14, 15, 17, 72, 85
106 Handbook of Laparoscopy Instruments Yeshwant Ramrao Lamture
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irreversible 72
Denaturing enzymes 15
Devices 14, 23, 25, 39, 40, 41, 44, 57, 69, 80,
81, 87, 89, 90, 97, 98, 100
electrosurgical 87
heating 44
hemostatic 89, 90, 100
orthopaedic 87
suction-irrigation 69
Dilators 89, 90, 98, 100
wire-guided bougie 98
Discomfort, pressure-related chronic 1
Dissection 29, 56, 59, 63, 64, 66, 69, 70, 78,
80, 88
blunt 56, 64, 69, 70
planes 29
Dissectors, ultrasonic 88
DVD recorders 36
E
Ectopic pregnancy rupture 69
Effects 71, 73, 74, 79, 80, 84, 85, 86, 96
cavitation 79, 80, 84
cooling 86
cutting 73, 74, 79
electrosurgical 71
insulating 86
photo-thermal 85
superficial 96
vessel sealing 79
Efficiency, transfer 8
Electric shock 72, 73
Electrical adapter 64
Electrocautery 18, 64
knife 64
Electrodes 74, 75, 77, 81, 85, 86, 95
dispersive 85
Electromagnetic radiation 85
Electrosurgery 56, 64, 66, 70, 71, 75, 87
argon gas coagulation 71
hooks 56, 64, 70
radiofrequency 71
Electrosurgical unit, non-contact monopolar
coagulation 81
Element sofergonomics 3
Emulsification 84
Endoscope 89, 90, 91, 96, 97, 98, 99, 100
technology 100
Endoscopic 30, 42, 78, 89, 90, 96
accessory devices 90
band ligation (EBL) 89, 96
lighting 30
perforator surgery for varicose veins 42
procedures 78
treatment 96
Endoscopic placement 100
transnasal 100
Endoscopist 93
Endoscopy 20, 21, 30, 89, 90
encountered endoscopic 89
gynecological 30
Energy 30, 72, 75, 79, 80, 85, 88, 96
electric current 72
electrical 30, 75
real-time adjusted 80
ultrasonic 79
Enteral 89, 90, 99
feeding 89, 90
nutrition 89, 99
Epinephrine 89, 92
Equipment, anaesthesia 23
Ergonomic(s) 3, 9
inefficiency 9
physical 3
Esophageal strictures dilatations 98
F
Fallopian tube 59
Fibrinogen 92
Fibroid, hard 68
Field, electrostatic 78
Fluoroscopy 99
Food and drug administration (FDA) 103
Foot 6, 75
pedal location 6
switch 75
Forceps devices 97
Foreign body-related reactions 80
Fulguration 71, 72, 74
G
Gas 15, 24, 39, 41, 42, 43, 44, 46, 50, 51, 72,
82, 96
carbon dioxide 44
cylinders 24, 39, 41
embolism 42, 82
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embolization 96
insufflator 50
sterilization 15
supplies 42
tubing 39, 44, 46
Gastric arteries 80
Gastroesophageal junction 99
Gastrointestinal tract lumen 98
Generator 79, 82, 83, 85
electrosurgical 85
ultrasonic 79, 82, 83
Glue injection procedures 97
Glutaraldehyde 16
Graspers 23, 56
intestinal 56
toothed 23
Gynecological surgery 103
H
Haemorrhage 53
Haemostasis 63, 87, 92
Harmonic devices 79
Hawthorne effect 1, 2
Heat 33, 79, 81, 86, 87
electric 81
filters 33
production 86
sink 86, 87
vibration-generated 79
Heater probes 89, 94
Hemoclip application 92
Hemodynamic complications 41
Hemostasis 89, 91, 92, 93, 95, 96
Hemostatic agent 91
Hepatectomy 81
Hook scissors 23, 64
Hot filament evaporates 32
Hypothermia 44, 46
I
Imaging processing equipment 102
Imersion of metallic instruments 16
Incision 1, 92
mucosal 92
Infected instruments 17
Infective cystitis 81
Inferior mesenteric artery 80
Infertility-related gynaecological procedures
85
Injection therapy 92
Injuries 51, 53, 77, 78, 79, 80, 84
electrical 79
magnitude tissue 78
thermal 80, 84
vascular 51
Instruments, suction-irrigation 69
Insufflator 22, 24, 39, 40, 42, 43, 44, 46
alarm 24
Insulated hand instruments 15
Insulation 57, 77, 78
failure 77, 78
Integrated irrigation 95
Intraperitoneal pressure 40, 42
Irrigation 69, 82, 84, 95
fluid 69, 84
mechanical 95
system 82
L
Laparoscopic 1, 2, 4, 5, 7, 8, 9, 10, 18, 25, 27,
29, 30, 35, 39, 40, 44, 46, 56, 59, 68, 78,
79
cameras 35
cyst extirpation 59
devices 39
gastrointestinal 79
Insufflator 40
light sources 30
myomectomy 68
surgeries 1, 4, 5, 6, 8, 9, 10, 18, 25, 27, 29,
44, 46, 56, 59
Laparotomies 1, 2, 59
Luminescence 30
M
Malfunction 78
Metal cylinders 79
Metallic instruments 16
Metamorphosis 3
Method, thermal coagulation 95
Metzenbaum scissors 23
Mist production 80
Monopolar 66, 71, 75
electrosurgery 71, 75
108 Handbook of Laparoscopy Instruments Yeshwant Ramrao Lamture
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hand instruments 66
Mucosal protection devices 97
Myoma 68
fixation 68
giant 68
Myomectomies 66
N
Neck tumors 71
O
Optical 29
devices in laparoscopic surgery 29
fibers 29
Ovarian endometriomas 69
P
Per-oral endoscopic myotomy (POEM) 93
Photonic crystal fibers 85
Probe 23, 66, 79, 94, 95
coagulating 66
electrocoagulation 94
Procedure, haemostatic 30
Protein coagulation 89
R
Radiofrequency energy 85, 88
device 88
Radiology technician 24
Refractory gastroparesis 100
Returning 75, 77, 78
electrode 75, 77, 78
electrode monitoring system 76
Reusable devices 57
Right-angled dissector 23
Robotic systems 19, 103
Role of robotic surgery 9
S
Scissors 22, 56, 57, 64, 67, 70
bipolar electrocoagulation 64
ultrasonic 22
Sclerotherapy 91
Skin burns 78
Steam 14, 17
sterilization 14, 17
sterilizer 14
Sterilization 14, 16
processes 14
systems 16
Sterilizing instruments 16
Suction 44, 69, 84
aspirator 84
irrigation machine 44
pump 69
tube 84
Surgery 6, 29, 41, 79, 85
endoscopic 6, 85
gastrointestinal 79
hysteroscopic 29
intraperitoneal 41
T
Therapy 92, 97, 104
glue injection 97
injection needle 92
Tissue 72, 73, 75, 88
effects 72, 73, 75
malignant 88
Transducer 75, 82, 83, 84
magnetostrictive 84
Trauma 52, 56, 59, 102
Traumatic 52, 56, 59
grasping forceps 59
V
Vapour pressure 72
Vibrations, ultrasonic 75, 79
W
Waves 72, 75
frequencies 75
ultrasonic 72
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