Laparoscope - (Part 2)

ROBOTIC-ASSISTED LAPAROSCOPY:

Robotic surgery or robotic-assisted surgery, allows doctors to perform many types of complex procedures with more precision, flexibility and control than is possible with conventional techniques. Robotic surgery is similar to laparoscopic surgery in which they both use small incisions, a camera and surgical instruments. 

It is also sometimes used in certain traditional open surgical procedures, instead of holding and manipulating the surgical instruments the surgeon will sit at a computer console and use the console to manipulate the robot. The console provides the surgeon with high definition and magnified 3D images. A doctor uses robotic arms to operate through small keyhole incisions in the abdomen. The robotic arms are able to do surgical tasks with increased range of motion. They also can filter out hand tremor. The special tools translate the doctor’s larger hand movements into smaller ones. This allows delicate work to occur in small spaces. The 3D image provides a clear vision and increased accuracy. 

Robotic surgery provides your surgeon with a greater range of motion and precision compared to conventional laparoscopic surgery. In robotic surgery, the post-operative pain and bleeding are less.

HOW ROBOTIC SURGERY IS PERFORMED:

• During robotic surgery with the help of the robot, your surgeon makes small incisions in your body.

• The miniaturized instruments and high definition three- dimensional camera are inserted.

• The surgeon manipulates these instruments to perform the operation from the nearby console.

• With the help of the control buttons, the machine translates your movement into real-time, your movements are shown in the monitor.

• There is a camera inside your body, which sends real-time images to your surgeon.

• During a robotic surgery procedure, your surgeon uses master controls to manipulate the instruments and the instruments translate your surgeon’s movement into precise movements inside your body.

• The robotic devices provide greater dexterity and range of motion than human, it allows your surgeon to perform delicate surgeries successfully.

IMAGES OF ROBOTIC AND CONVENTIONAL LAPAROSCOPIC SURGERY:

CONVENTIONAL LAPAROSCOPIC SURGERY

ROBOTIC ASSISTED LAPAROSCOPY IMAGE

STERILIZATION AND CLEANING PROCEDURE OF THE LAPAROSCOPIC INSTRUMENTS AFTER SURGERY:

Sterilization is a process of eliminating or destructing all forms of microbial organisms. This sterilization can be achieved with steam, gas or chemicals. Many hospitals have a central sterile department where the instruments are transported from the operating room for processing. There is a process called disinfection in which it eliminates pathogenic organisms except for spores. Disinfection is mainly classified into three different processes they are: 

1. High level: In this, all life forms except spores are destroyed.
2. Intermediate level: In this fungi, viruses, and spores are spared.
3. Low level: In this fungi, viruses, spores and mycobacteria remain undestroyed.

For laparoscopic instruments sterilization or high-level disinfection are needed. There are some process is needed to clean the laparoscopic instruments they are:

1. Dismantling
2. Decontamination
3. Pre-cleaning
4. Cleaning and rinsing
5. Drying
6. Sterilization.

• DISMANTLING: Based on the design of the laparoscopic instruments dismantling varies. 

• DECONTAMINATION: It is the process used to reduce bio-burden on reusable medical devices. The process begins with removing or wiping of blood tissue and body fluids from the instruments with the help of a sterile sponge. After this all contaminated instruments are placed in the container containing the disinfectant solution such as 0.5% chlorine, allowing them to soak for 10 minutes. The instruments are not left for more than 10 minutes because it gets damaged.

• CLEANING: The instrument which is designed for autoclaving requires prior specialized cleaning and sterilization. The user ensures that no residual, organic residue remains on the instrument surface, especially the instruments having several small moving parts because it may lead to corrosive damage and pathogenic colonization. The cleaning process includes washing their instruments with soap but this is not effective compared to enzymatic and detergent-based cleaners. Use of soft brushes on the laparoscopic instruments results in thorough cleaning.

• RINSING: Laparoscopic instruments are best rinsed in running water so that all particulate matters, as well as residues of chemicals used for contamination and cleaning, are completely cleared from them. The usage of jet water is far better than the usage of rinsing them in stagnant water.

• DRYING: The instruments should be dried at the end of cleaning and rinsing before they are sterilized. This is achieved by using an air that blows all the water droplets off the surface of the instruments.

• STERILIZATION: The rigid laparoscopic instruments are sterile or if that is not feasible, that they be high-level disinfected. There are some three types of sterilization process include they are steam, ethylene oxide

1. STEAM STERILISATION: steam sterilization in an autoclave is one of the most common forms of sterilization. Autoclaving at 121°C for 45 to 60 minutes. It is effective, cheap and non-toxic. Before sterilization, all instruments are insulated and all cords must be doubly wrapped in a cloth prevent contact with the hot metallic container. They are then placed in the autoclave. Sterilization is carried out at 135°C for 4 minutes, this method requires post-vacuum.
2. LOW-TEMPERATURE STEAM AND FORMALDEHYDE (LTSF) STERILIZATION: The heat-sensitive instruments are sterilized by this method, it takes 5-6 hours depending on the temperature.
3. GAS STERILIZATION: The ethylene oxide is suitable for all disposable instruments, insulated hand instruments and tubings used for gas, suction and irrigation. Laparoscopic instruments may be sterilized with either cold or warm ethylene oxide gas depending on the manufacturer instructions. With cold gas the temperature is at 85°C it exposed for 4 hours and 30 minutes. Warm gas sterilization takes place at 145°C for 2 hours 30 minutes, followed by 8 hours aeration. This method of gas sterilization has advantages that the instruments are not damaged, non-corrosive. The disadvantage is cost and toxicity.
4. HIGH-LEVEL DISINFECTION: The high-level disinfection is used when sterilization is not available or not feasible. It eliminates bacteria, fungi, viruses and parasites. The agents that are used are 2% glutaraldehyde, 6% stabilized hydrogen peroxide and per acetic acid.

Nowadays work load are high so the turnaround timed for instruments that cannot be sterilized with steam or heat. So a new method is known as STERRAD in which it uses hydrogen peroxide vapour and low-temperature gas plasma to sterilize most devices quickly with no toxic residues. This process takes 75 minutes.

MAINTENANCE:

1. Keep the instruments free of gross oil during surgical procedures.
2. The staff who done reprocessing must know the correct process.
3. Minimizing the length of time between instruments leaving the surgical field and the beginning of the cleaning process.
4. Proper cleaning procedure must be carried out.
5. Sterilize the instruments according to the manufacturer’s instruction.
6. Having the right cleaning equipment and solutions in the right place.
7. After surgery decontamination process is carried out using the spray on moisturizers where it is an effective way to prevent blood from drying.
8. Proper cleaning brush must be used based on the instrument.

POSSIBLE TECHNICAL PROBLEMS IN LAPAROSCOPY:

• Sometimes gas tubing is not connected to the stack causes low or no insufflation pressure.
• The CO2 tank becomes empty or running low on volume.
• The gas valve present in the port is not opened so that it creates issues in gas supply during surgery.
• Excessive suctioning cause damaged gas tubing which leads to intra-abdominal is issues.
• Gas insufflation problem caused by the obese patient.
• Sometimes the picture is not clearly displayed on the monitor. This is due to power off or sudden loss of light source.
• Poor image quality can be occurred due to little light, blurring, foggy and distortion.

HOW TO TROUBLESHOOT THESE PROBLEMS:

• Connect the gas tubing properly before the procedure.
• Check the gas tank properly, if it is empty change the gas tank.
• Open the gas valve completely thereby avoiding issues during surgery and also secure the gas tubing properly.
• Use lower suction pressure and allow time to reinflate.
• Use high gas insufflation to avoid the problem for the obese patient.
• Check the connections properly and check the lamp present in the light source sometimes it may burn.
• Clean the connection between camera and laparoscope, correct the lenses etc.

DIFFERENCE BETWEEN LAPAROSCOPIC AND ROBOTIC SURGERY:

LAPAROSCOPIC SURGERY:

1. The incision made in the laparoscopic surgery is the tiny incision.
2. The surgical instrument used in laparoscopic surgery is the camera and a small instrument.
3. During surgery, the surgeon stands next to you.
4. The surgery is performed by the surgeon where they operate using the instruments previously inserted in the incisions.
5. In conventional laparoscopy, a limited range of motion can be used.
6. Conventional laparoscopy has reached the body parts compared to open surgery due to smaller instruments but less when compared with robotic surgery.
7. The recovery time needed for laparoscopy is shorter compared to traditional surgery.
8. The risk of blood loss and infection is rare.

ROBOTIC SURGERY:

1. The incision made in robotic surgery is the tiny incision.
2. The surgical instrument used in the robotic surgery is the camera, small instrument, surgeon’s console and endo wrist instruments.
3. During surgery, the surgeon stands at the console.
4. The surgery is performed by the surgeon directs the robot’s movements from the console, the robotic instruments in your body responds in real-time.
5. In robotic surgery, the robotic instruments can able to rotate full 360 degrees and are more flexible than human arms.
6. The ability to access the places is incomparable, the robot has the dexterity to reach previously inaccessible areas of the body.
7. The recovery time needed for robotic surgery is shorter compared to traditional surgery.
8. The risk of blood loss and infection is rare.

👉 Please Watch Our ROBOTIC-ASSISTED LAPAROSCOPY Video (Part 3) from Our YouTube Channel Below:-

1. Part 3 Video:-

REFERENCE:

• https://www.bupa.co.uk/health-information/womens-health/gynaecological-laparoscopy
• https://www.healthline.com/health/laparoscopy
• https://www.webmd.com/digestive-disorders/laparoscopic-surgery#1
• https://medlineplus.gov/lab-tests/laparoscopy/
• https://www.sciencedirect.com/topics/nursing-and-health-professions/laparoscope
• https://www.nhs.uk/conditions/laparoscopy/
• https://www.surgicalinstruments.com/general-lap-bariatric-instruments/laparoscopic-surgical-instruments
• https://www.surgicalholdings.co.uk/laparoscopic-instruments.html
• https://www.ncbi.nlm.nih.gov/pubmed/7773462
• https://link.springer.com/chapter/10.1007/978-1-4612-2480-8_6
• https://www.cdc.gov/infectioncontrol/guidelines/disinfection/cleaning.html
• https://www.anderseneurope.com/eto-sterilisation/ethylene-oxide/sterilisation-of-laparoscopic-equipment
• https://www.wkhs.com/cancer/cancer-treatment-services/surgery/robotic-surgery/robot-assisted-laparoscopic-procedures
• https://blog.providence.org/archive/laparoscopic-and-robotic-surgery-what-s-the-difference
• https://www.mayoclinic.org/tests-procedures/robotic-surgery/about/pac-20394974

👉..... Click Here to Read Part 1 .....👈

Article Written By:-

👉 Surya@Kruthiga