Laparoscopic instruments are made of durable materials and usually high quality stainless steel. Instruments all have a very narrow shaft so that they can fit inside laparoscopic ports. Sizes typically range from 3 mm, 5 mm and 10 mm sizes. A variety of tips are available for manipulating the tissue and handle styles may allow ergonomic rotating, grasping and locking abilities in a precise fashion.

Laparoscopic instruments are used along with a laparoscope, which is a thin telescope fitted with a cold light source and a video camera. Inert gases like carbon dioxide are used to inflate the abdominal region which increases the distance between the organs and the abdominal wall thus enlarging the operating field. Common instruments used during laparoscopic procedures include a: LAPAROSCOPE, NEEDLE DRIVER FOR SUTURING, TROCAR, BOWEL GRASPER and SURGICAL MESH.

LAPAROSCOPE

Surgical scopes are one of the oldest instruments used by medical practitioners since ancient times. Modern surgical laparoscopes used for minimally invasive procedures are a far cry from the simple hollow tubes that gradually developed to include lenses for magnified vision. Today, scopes are more like an apparatus with multiple parts that include a CCD camera, viewing device, lens cleaner, and an energy-supply device.

NEEDLE DRIVER

A needle holder is used by laparoscopic surgeons to hold suturing needles when closing wounds. Forming slip-knots to close wounds and surgical incisions requires precise skills. Suturing can often be tricky to use owing to the property of “memory” which causes tissue to resist deformation. Needle holders have three parts – the jaws, joints, and handles. The instrument, including disposable laparoscopic instruments and reusable laparoscopic instruments, is classified as straight or curved depending upon the shape of the jaws.

TROCAR

Along with the probe, scalpel, and cannula the trocar is one of the oldest implements used by medical practitioners. A trocar is shaped like a pen and has a sharp triangular point. Trocars are typically placed inside hollow cannulas and introduced inside body cavities to assist in draining fluids. Trocars are now referred to as both the initial entry device as well as the hollow cannula used during the operation. These instruments play an important role in laparoscopic surgery. Instruments such as scissors and graspers are introduced using surgical trocars.

Disposable or reusable?

The cost effectiveness of disposable versus reusable instruments is a subject of debate. The choice of the instrument is multifactorial and depends on function, reliability and cost. So, during most laparoscopic procedures, a combination of disposable and reusable instruments is used. Frequently, disposable trocars and scissors are used, while reusable instruments can be graspers, coagulation spatula/hook and needle drivers. The commonly used laparoscopic instruments are described below.

Uterine manipulators

These allow uterine positioning and expand operating space. Several uterine manipulators are available – the HUMI® (Cooper Surgical), the RUMI® (Cooper Surgical), Spackman, Cohen, Hulka, Valtchev, Pelosi and Clearview® (Endopath). Some are reusable while others are disposable. Most come with a channel to perform chromotubation; however, some (such as Hulka tenaculum and Pelosi) lack this channel. With 210˚, Clearview has the greatest range of motion in the anterior-posterior plane. Hulka tenaculum, Spackman’s and Cohen’s have a straight shaft, hindering their range of motion and limiting their use in advanced laparoscopic accessories and procedures.

Veress needle

This is a specially designed needle with a blunt-tipped, spring-loaded inner stylet and a sharp outer needle, used to achieve pneumoperitoneum while performing closed laparoscopy with ultrasonic system. It is available in disposable and reusable form, with 12cm or a 15cm length.

Most injuries in minimally invasive surgery are associated with primary port insertion, leading to an unresolved debate on the benefits of various entry techniques (open, closed or direct entry). There is no evidence that any single technique is better in preventing major vascular or visceral complications, though there is a higher risk of failed entry with closed entry. The most recent Cochrane review concluded there is a lower risk of vascular injury with the direct entry in comparison to use of Veress needle.3