Rigid Laparoscope Research Articles

Evaluation of surgical performance with standard rigid and flexible-tip laparoscopes

Flexible-tip laparoscopes have recently been introduced into clinical practice, with the goal of improving surgeon performance during complex laparoscopic procedures. We used objective and subjective performance parameters to compare standard rigid 0 degrees and 30 degrees lens laparoscopes two flexible-tip laparoscopes in an in vitro model. Twenty-nine subjects with varied levels of surgical experience performed complex laparoscopic tasks in three different models simulating (a) prostate dissection from the rectum, (b) cystic duct clipping, and (c) distal posterior rectum dissection. Each task was performed using two Storz rigid laparoscopes (0 degrees and 30 degrees) and two flexible-tip laparoscopes, the Olympus LTF-V3 and the Fujinon EL2-TF310. The sequence of application of the two flexible-tip laparoscopes was randomized. In each case, an experienced laparoscopic camera driver controlled the field of vision. Time to complete each task, operative precision, and subjective surgeon rating scores were compared. Statistical analysis was performed with analysis of variance (ANOVA) and a two-sided fisher's exact test. In all three models, the flexible laparoscopes offered no advantage in terms of procedure time, surgical precision, or subjective surgeon rating score when compared with the 30 degrees lens rigid laparoscope. The 30 degrees rigid lens laparoscope and the two flexible-tip laparoscopes were superior to the 0 degrees lens rigid laparoscope for all parameters evaluated, with the exception of subjective rating in the cystic duct model and procedure time in the colorectal model. In this in vitro experimental model, the flexible-tip laparoscopes found to have no advantage over the standard rigid 30 degrees lens laparoscope. These models were validated, as the 0 degrees lens rigid laparoscope was surpassed by the 30 degrees lens rigid laparoscope and the flexible-tip laparoscopes. Both flexible-tip laparoscopes produced similar results and excellent image quality, but some experience is required before their smooth application can be achieved.

Laparoscopic surgery update for gastrointestinal malignancy.

All laparoscopic surgery is performed under general anesthesia. A flexible or rigid laparoscope is used for visualization, and surgeons perform operations under the guidance of a videoscopic view on a monitor. Several additional ports for working forceps or scissors are inserted under videoscopic view. All laparoscopic procedures are performed with long straight instruments that are introduced through the working ports; these include scissors, forceps, knives, and those associated with electrocautery and suction. These instruments are limited in their motion by the fixation enforced by the abdominal wall ports. The peritoneal cavity can be expanded by insufflation of CO2 gas to 10 mmHg, allowing creation of a large space between the anterior abdominal wall and intraperitoneal viscera. Laparoscopic surgery requires surgeons to infer the shape of the internal organs of patients from two-dimensional (2-D) displays on a video monitor. Surgeons perform operations with no tactile feedback to their hands and with a motion limitation dictated by the laparoscopic instruments. Although early in the era of laparoscopic surgery previous abdominal operations were considered as a relative contraindication to laparoscopic procedures, currently most patients with postoperative adhesion are amenable to a laparoscopic approach by careful dissection of the adhesions under videoscopic view.

Forward-imaging instruments for optical coherence tomography

We discuss the design and implementation of forward-imaging instruments for optical coherence tomography (OCT), which require the delivery, scanning, and collection of single-spatial-mode optical radiation. A hand-held surgical probe for use in open surgery can provide cross-sectional images of subsurface tissue before surgical incisions are made. A rigid laparoscope for minimally invasive surgical OCT imaging provides a simultaneous enface view of the area being imaged. OCT imaging is demonstrated on in vitro human specimens.

Microlaparoscopy: diagnostic and sterilization without general anaesthesia: a safe, practical and cost‐effective technique

The aim of the study was to assess the technique of ‘microlaparoscopy’, i.e. the use of a small diameter (2.2 mm outer diameter or less) rigid laparoscope for outpatient diagnostic and sterilization purposes without general anaesthesia. Volunteer patients were offered and underwent either diagnostic laparoscopy using local anaesthesia alone, or laparoscopic sterilization using both local anaesthesia and intravenous sedation. There were no control groups. The setting was a purpose‐built private outpatient facility, 3 miles from a district general hospital, and the subjects included 52 volunteer patients (10 for sterilization and 42 for diagnostic laparoscopy). All operations were carried out successfully without complication and with good patient acceptability. Microlaparoscopy is a useful tool for performing both diagnostic and sterilization laparoscopy in an outpatient setting, and avoids the need for general anaesthesia. The procedures are safe and cost effective, provided adequate facilities are properly designed and utilized.

Removal of a broken pancreatic stent using a new stent retrieval device

These results indicate that it is feasible to form anastomoses using flexible endoscopes and accessories that are inexpensive and easy to construct. It is likely to be possible to insert similar buttons by means of a rigid laparoscope and to form anastomoses at several other anatomical sites. Furthermore, the technique might be modified to allow delivery of a circular ring of staples to increase the security of the anastomosis. One example of a potential clinical application of such a method is the formation of gastrojejunostomy