Instruments and devices used in laparoscopic surgery
- Jon Gould, MD
Jon Gould, MD
- Professor of Surgery
- Medical College of Wisconsin
- Todd A Ponsky, MD, FACS
Todd A Ponsky, MD, FACS
- Associate Professor of Surgery and Pediatrics
- Akron Children's Hospital
- Jeffrey Blatnik, MD
Jeffrey Blatnik, MD
- Assistant Professor of Surgery
- Washington University School of Medicine
- Section Editors
- Jeffrey Marks, MD
Jeffrey Marks, MD
- Section Editor — Minimally Invasive Surgery
- Professor of Surgery
- University Hospitals
- Case Medical Center
- Tommaso Falcone, MD, FRCSC, FACOG
Tommaso Falcone, MD, FRCSC, FACOG
- Section Editor — Minimally Invasive Gynecologic Surgery
- Professor of Obstetrics and Gynecology
- Cleveland Clinic Lerner College of Medicine
Minimally invasive surgery has undergone significant advances and has changed the way operations are performed. Technological advances have produced progressively smaller laparoscopic instruments and higher-quality imaging that allow laparoscopic surgeons to perform precise dissection with minimal bleeding through most dissection planes, even those that are highly vascular.
Adequate hemostasis is essential during laparoscopic procedures to ensure a clear view of the operating field. The need to convert to an open procedure negates the advantages of the laparoscopic approach. Primary prevention of bleeding through the use of various laparoscopic devices to carefully dissect and identify vascular structures prior to dividing them (as needed) is fundamental. However, when bleeding does occur, these devices can also be used to safely and efficiently achieve hemostasis to allow the procedures to continue laparoscopically. (See "Complications of laparoscopic surgery", section on 'Management of hemorrhage'.)
This topic will discuss devices and techniques available for laparoscopic imaging, dissection, and control of bleeding encountered during laparoscopic surgery. Abdominal access techniques are discussed in detail elsewhere. (See "Abdominal access techniques used in laparoscopic surgery".)
Laparoscopic surgery refers to surgical procedures that are performed through one or multiple small incisions, rather than through a larger, usually single, incision through the abdominal wall. Advantages of laparoscopy over laparotomy include smaller scars, quicker recovery, decreased adhesion formation  and, for some procedures (but not all), less bleeding, fewer complications, and shorter procedure duration [2-6]. However, in many cases, the risk of major complications (pulmonary embolus, transfusion, fistula formation, major additional unplanned surgery) may be similar for the open and laparoscopic approaches to a given procedure. The advantages and disadvantages of the laparoscopic approach for specific procedures are discussed in separate topic reviews.
Depending upon the nature of the specific surgical procedure, laparoscopic entry can be performed using a closed (Veress needle, optical access) or open technique (Hasson technique). Once pneumoperitoneum has been established, one or more ports are placed through which the camera and instruments are passed. Techniques for laparoscopic entry are reviewed in detail elsewhere. (See "Abdominal access techniques used in laparoscopic surgery" and "Abdominal access techniques used in laparoscopic surgery", section on 'Single-incision surgery (SIS)'.)
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- LAPAROSCOPIC SURGERY
- CHALLENGES OF LAPAROSCOPIC SURGERY
- IMAGING SYSTEMS
- - Anatomy of a rigid laparoscope
- - Light source and fiberoptics
- - Imager
- - Video monitors
- - Three-dimensional imaging
- - Flexible endoscope
- - Laparoscopes for single-incision surgery
- In vivo fluorescence imaging
- LAPAROSCOPIC TROCARS
- DEVICES FOR DISSECTION
- Grasping instruments
- - Instruments for single-incision laparoscopy
- - Instruments for mini-laparoscopy
- Suction and irrigation
- Tissue removal
- - Morcellators
- - Tissue bags
- DEVICES FOR HEMOSTASIS
- Surgical clips
- Suture ligation
- Surgical staplers
- - Gastrointestinal
- - Vascular
- - Advanced bipolar sealing
- - Ultrasonic desiccation
- - Radiofrequency ablation
- Laser fulguration
- Other devices
- Choice of device
- SUMMARY AND RECOMMENDATIONS