The Ultimate Guide to Choosing Laparoscopic Instrument

Laparoscopic surgery has become an indispensable tool in modern surgical practice. Whether you are performing a routine gallbladder removal, a complex colorectal procedure, or a delicate gynecological surgery, the choice of laparoscopic equipment plays a pivotal role in the success and safety of the procedure. Selecting the right laparoscopic surgical equipment tailored to your specialty is key to optimizing surgical outcomes, improving patient recovery, and enhancing your performance in the operating room.

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However, with so many options available in the market, choosing the right tools can be overwhelming. This guide will help you navigate the complexities of selecting laparoscopic equipment for your practice, ensuring that you make informed decisions. It covers essential tips, best practices, and common mistakes to avoid in selecting laparoscopic surgical equipment for your specialty.

1. Understanding Your Specialty’s Needs

Laparoscopic surgery is not a “one-size-fits-all” approach. Different specialties demand different equipment due to the variation in procedures, anatomy, and surgical goals. Understanding your specialty’s needs is crucial for choosing the right laparoscopic equipment.

• General Surgery: In general surgery, common procedures like cholecystectomy, appendectomy, and hernia repairs are frequently performed. Surgical instruments need to be versatile, durable, and able to navigate complex abdominal regions.
• Gynecology: Gynecological laparoscopy involves procedures such as hysterectomies, tubal ligation, and ovarian cyst removal. Specialized instruments with precise maneuverability, compact sizes, and the ability to handle delicate tissues are essential.
• Colorectal Surgery: Colorectal laparoscopy, which includes procedures like bowel resections and stoma creation, requires advanced imaging and tools that can facilitate access to deep pelvic areas.
• Urology: Urological laparoscopic procedures, such as nephrectomy or prostate surgery, demand high-quality optics and specialized tools for handling delicate organs and performing precise dissection.

Knowing the demands of your specialty will help you prioritize features like instrument length, flexibility, and the type of visualization system required for optimal surgical precision.

2. Core Components of Laparoscopic Equipment

Before diving into specific instruments and tools, it’s essential to understand the core components of laparoscopic equipment. Laparoscopic surgeries rely on a combination of instruments designed for access, visualization, and manipulation of internal organs. Here are the primary categories of laparoscopic surgical equipment:

• Trocars and Cannulas: These create the entry points for laparoscopic instruments. They need to be durable, sharp and designed to minimize trauma to surrounding tissues.
• Endoscopes and Cameras: High-definition cameras are critical for providing clear visualization of the surgical field. A robust endoscope with good light transmission is essential for both diagnostic and therapeutic laparoscopic procedures.
• Surgical Instruments: These include graspers, scissors, dissectors, staplers, and forceps. Depending on the procedure, some specialties require specialized instruments such as bipolar cautery, ultrasonic dissectors, or scissors for precise cutting.
• Insufflation Systems: These devices pump carbon dioxide into the abdomen to create a pneumoperitoneum, providing space to work. The insufflator must be reliable and capable of maintaining stable pressures throughout the procedure.
• Electrosurgical Units (ESUs): These are used for coagulation, cutting, and dissection during surgery. Ensure that the unit offers adjustable power settings and is compatible with your other instruments.

3. Factors to Consider When Choosing Laparoscopic Surgical Equipment

When selecting laparoscopic equipment, several factors come into play. The right equipment will depend on your personal preferences, hospital or clinic needs, and the specific procedures you perform regularly. Here are the key factors to consider:

3.1. Quality and Durability

Laparoscopic surgical equipment is an investment that should provide years of reliable service. Low-quality instruments or equipment that easily degrade can compromise patient safety and increase long-term costs. Look for equipment from reputable manufacturers with a proven track record of durability, such as Karl Storz, Olympus, Stryker, and Medtronic.

3.2. Precision and Control

The quality of control over instruments during surgery is critical, especially in delicate procedures. Instruments should be ergonomically designed, lightweight, and allow for fine motor control.

• Ergonomic Handles: These reduce fatigue during long procedures and provide better grip and maneuverability.
• Instrument Length and Flexibility: The length of laparoscopic instruments must match the type of surgery you are performing, ensuring proper reach and accessibility.

3.3. Visualization

A high-quality visualization system is essential to the success of laparoscopic surgery. The camera should provide clear, high-resolution images to guide the surgeon throughout the procedure. For high-precision surgeries, the ability to adjust light intensity and focus is essential. Additionally, consider the following:

• Camera Resolution: High-definition (HD) or 4K resolution systems provide detailed images.
• Light Source: LED light sources offer bright, consistent lighting without overheating.
• Monitor Size and Placement: Ensure that the monitor is placed in a comfortable position for the surgical team.

3.4. Compatibility with Existing Systems

When selecting laparoscopic equipment, ensure that new instruments or systems are compatible with your existing tools and the hospital’s infrastructure. This includes power sources, camera systems, and sterilization equipment. Additionally, some equipment brands have proprietary technology that may not integrate seamlessly with tools from other manufacturers.

3.5. Cost Considerations

While high-quality laparoscopic equipment is crucial, cost is often a determining factor. Be sure to consider the total cost of ownership, which includes the initial investment, maintenance, consumables (like trocar and camera tips), and potential replacement costs. Look for a balance between quality and cost-efficiency.

4. Types of Laparoscopic Surgical Equipment

Different procedures require different types of laparoscopic instruments. Below are some of the essential tools in laparoscopic surgery.

4.1. Trocars and Cannulas

• Optical Trocars: These provide visual access to the abdominal cavity and are essential for safe entry. They often include built-in cameras to guide placement.
• Bladeless Trocars: Designed to reduce tissue trauma and improve patient safety, especially when working in delicate areas.

4.2. Endoscopes and Cameras

• Rigid Endoscopes: Most commonly used for laparoscopic surgeries, providing high-quality visuals.
• Flexible Endoscopes: Used for more complex procedures where flexibility and maneuverability are needed.

4.3. Surgical Instruments

• Graspers and Forceps: Vital for holding, manipulating, and moving tissues.
• Bipolar and Monopolar Electrosurgical Instruments: Used for cauterizing or cutting tissue during surgery.
• Sutures and Staplers: Specialized for laparoscopic surgeries, often designed for minimal access and precise placement.

4.4. Insufflation Systems

The insufflator controls the amount of carbon dioxide pumped into the abdomen, maintaining the pneumoperitoneum required for laparoscopic procedures. A reliable insufflation system with adjustable pressure settings is vital for maintaining an optimal working space.

4.5. Electrosurgical Units (ESUs)

ESUs provide controlled energy for cutting, coagulating, or vaporizing tissue. They are essential for ensuring precision and minimizing bleeding.

5. Best Practices for Selecting Laparoscopic Equipment

To ensure you’re choosing the best laparoscopic equipment for your specialty, follow these best practices:

• Perform a Needs Assessment: Start by evaluating the specific requirements of your procedures. Identify the types of surgeries you frequently perform and the tools that make those surgeries safer and more efficient.
• Invest in High-Quality Imaging: Prioritize high-definition cameras and optimal lighting. A good visualization system is crucial for achieving the best surgical outcomes.
• Test Equipment Before Purchase: If possible, demo equipment in a clinical setting to ensure it meets your needs. Assess its ease of use, maneuverability, and performance.
• Ensure Compatibility: Check that the new equipment will work seamlessly with your existing infrastructure and instruments.
• Consider Sterilization Requirements: Laparoscopic tools need to be sterilized after each use. Ensure that the instruments you select are compatible with your hospital’s sterilization protocols.

6. Common Mistakes to Avoid

Even experienced surgeons can make mistakes when selecting laparoscopic equipment. Here are some common errors to avoid:

• Choosing Based on Price Alone: While cost is important, don’t compromise on quality. Low-cost equipment often leads to higher long-term expenses due to maintenance, repairs, or poor performance.
• Overlooking Ergonomics: Equipment that is not ergonomically designed can cause discomfort and fatigue during long surgeries, affecting your performance.
• Ignoring Compatibility: Always verify that the new equipment is compatible with your existing tools, especially when dealing with cameras, insufflators, and electrosurgical units.
• Not Considering Long-Term Support: Some manufacturers may offer great equipment but lack adequate after-sales support, warranties, or customer service.

7. Maintaining Laparoscopic Equipment

Once you’ve selected your laparoscopic equipment, it’s essential to maintain it properly to ensure its longevity and functionality. Regular cleaning, inspection, and servicing are essential for keeping your tools in optimal working condition. Develop a maintenance schedule, and follow the manufacturer’s guidelines for cleaning, storage, and inspection of equipment.

8. Final Thoughts

Choosing the right laparoscopic equipment for your specialty is a critical decision that impacts both the safety and efficiency of your surgeries. By understanding your specialty’s needs, carefully selecting tools based on quality, precision, and compatibility, and avoiding common mistakes, you can significantly improve the outcomes of your laparoscopic procedures.

Investing in high-quality laparoscopic surgical equipment tailored to your specialty will ensure that you perform the most effective, minimally invasive surgeries with confidence. Whether you’re a general surgeon, gynecologist, colorectal specialist, or urologist, taking the time to choose the right equipment will not only enhance your surgical capabilities but will also contribute to your patient’s well-being and recovery.

You know, laparoscopic surgery has really changed the game when it comes to how surgeries are done. It offers these minimally invasive options that mean quicker recoveries and way less discomfort for patients. I came across a report from Grand View Research that said the laparoscopic instruments market was around $11.5 billion back in , and it’s expected to grow at about 7.2% each year until . With more and more people looking for safe and effective surgical methods, picking the right Basic Laparoscopic Instruments is becoming super important for healthcare providers. It can really make a difference in patient outcomes and how smoothly surgeries go.

At HANGZHOU SUNSTONE TECHNOLOGY CO., LTD., we’ve been at this since , and we’re all about pushing the boundaries of modern surgery with innovative medical devices. Our focus on using absorbable medical consumables and biodegradable materials really sets us apart in the industry. When surgeons are sifting through all the options for Basic Laparoscopic Instruments, it's crucial to get a handle on the specifics of each tool and their benefits. This guide is meant to arm practitioners with the info they need to make smart choices about these essential instruments for their surgeries.

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Understanding the Basics: What Are Laparoscopic Instruments?

Laparoscopic instruments are these really cool specialized tools that are made for minimally invasive surgeries. You know, unlike the old-school open surgery that needs those big cuts, laparoscopic techniques only require tiny incisions. This means patients bounce back faster and experience way less pain afterward! It's super important for anyone in the medical field to grasp the different types of laparoscopic instruments out there if they want to deliver top-notch surgical care. So, let’s break it down a bit. There are a bunch of essential types of laparoscopic instruments, and each one has its own job during surgery. For example, graspers are used to grab and hold tissues, while dissectors are all about separating and cutting through tissue layers. Oh, and don’t forget about trocars and cannulas—they're what create those access points for slipping the instruments into the abdomen. Surgeons really need to get to know these tools inside and out to make their techniques shine and keep things safe and effective. Plus, with all the advancements in tech, there are now some awesome new laparoscopic instruments that really step up surgical precision and visibility. Think about high-definition cameras and specialty scopes—they give surgeons a crystal-clear view of everything happening during the operation, which helps a ton when making decisions on the fly. Knowing your way around these instruments is key to hitting those successful surgical outcomes and steering clear of complications. When healthcare professionals understand the ins and outs of laparoscopic instruments, they can pick the right tools tailored just for their specific surgical needs.

The Importance of Quality Instruments in Surgical Procedures

When it comes to surgery, the quality of the tools we use really makes a difference, you know? A study in the *Journal of Surgical Research* found that using top-notch laparoscopic instruments can significantly cut down on the time it takes for surgeries and lower the chances of complications. In fact, surgeries done with the good stuff had a 25% lower complication rate compared to those done with less impressive tools. This really highlights how important it is to choose reliable and well-made instruments.

But it doesn't stop there—the quality of our surgical tools is about more than just immediate results. According to a report from the *American College of Surgeons*, investing in quality instruments also leads to long-term perks like better precision during surgeries and fewer problems post-op. They even estimated that hospitals using high-quality instruments for laparoscopic surgeries saw a 15% boost in overall patient satisfaction and a drop in readmission rates.

So, for healthcare providers, making sure to use quality tools in laparoscopic surgeries is a big deal. Using subpar instruments can really throw a wrench in the works, not only messing with the surgery itself but also increasing the risk of something going wrong that could put patients at risk. When picking out instruments, it’s super important to go with manufacturers who have a solid reputation. After all, we want every surgical procedure to be done with tools that meet the highest safety and effectiveness standards.

Key Types of Laparoscopic Instruments Every Surgeon Should Know

When we talk about laparoscopic surgery, having the right tools is super important—not just for getting good results, but also for keeping patients safe. Laparoscopic instruments are specially made for these minimally invasive procedures, which means quicker recoveries and way less pain afterward for patients. Can you believe that over the last ten years, the American College of Surgeons reports that the use of laparoscopic techniques has jumped by more than 30%? That's just wild! It really shows how crucial it is to understand the key types of tools surgeons use in these operations.

Now, if we're diving into the world of Laparoscopic Tools, you definitely can’t overlook trocars. They're kind of the VIPs in this toolkit, acting as the go-to access points for the laparoscope and other instruments. A study in the Journal of Laparoendoscopic & Advanced Surgical Techniques pointed out that where and how you place these trocars can seriously affect how smoothly a surgery goes and how fast a patient recovers. So yeah, they’re kind of a big deal! Plus, you've got graspers and scissors that are custom-made for laparoscopic procedures, letting surgeons move tissues around and make precise cuts without causing too much trauma—super important when you’re dealing with delicate stuff.

And let’s not forget about energy devices, like electrosurgical pencils and ultrasonic scalpels. These high-tech tools are game-changers for cutting and coagulating tissues, and they really help cut down on blood loss during surgery. Research from the Surgical Innovations journal shows that using these energy-based devices can make laparoscopic procedures more effective, which could mean shorter ops and faster healing for patients. As things keep evolving in surgery, it's key for any surgeon looking to up their laparoscopic game to stay in the loop about these essential instruments.

How to Assess the Durability and Reliability of Surgical Tools

When you're picking out laparoscopic instruments for surgery, you really want to prioritize durability and reliability. You know, a report from the International Journal of Surgery points out that when instruments fail during operations, it can lead to longer surgery times and some serious complications. So, having high-quality tools isn't just a nice-to-have—it's a must! It's also super important to check what materials the instruments are made from. Stainless steel and titanium are the go-to options because they last longer and are way more resistant to corrosion. And there's this study by the American College of Surgeons that found instruments made from these materials tend to break less often, which is a huge win when you're in the middle of a critical procedure.

Now, let's talk about the design of these tools—man, that can make a world of difference in how dependable they are. Ergonomically designed instruments not only give surgeons a better grip, but they also help reduce fatigue, which can definitely lead to mistakes during surgeries. A survey from the Society of American Gastrointestinal and Endoscopic Surgeons even showed that surgeons felt 80% more satisfied with user-friendly instruments. That’s a big deal because it shows how crucial it is to choose tools that feel good in your hands and give you control, ultimately making a real impact on surgical outcomes.

And hey, don’t forget about the manufacturer's reputation and the kind of after-sales support they offer—it can really affect how reliable those instruments are. According to Healthcare Purchasing News, tools that come with solid warranties and good customer service can create a much healthier surgical environment. So, by keeping these factors in mind, surgical teams can make sure they’re well-equipped with tools strong enough to handle the demands of surgery while also keeping patient safety and operational efficiency in check.

Ergonomics in Laparoscopic Instruments: Enhancing Surgeon Comfort

When it comes to laparoscopic surgery, ergonomics is a game changer that really impacts how surgeons perform and, of course, the results for patients. The physical toll these procedures can take on surgeons is no joke, and there’s a noticeable trend of ergonomic injuries, especially among female surgeons. As they handle those intricate instruments and hold some pretty awkward positions for long stretches, the risk of strain goes way up. So, getting a grip on these ergonomic challenges in the operating room is super important for any surgical team that wants to work efficiently while also taking care of their own health.

To tackle these challenges head-on, choosing the right basic laparoscopic instruments should really focus on comfort and functionality. Surgeons need tools that aren’t just precise for delicate tasks but also easy to handle to cut down on fatigue. Instruments designed with ergonomics in mind can seriously help ease the physical strain, allowing surgeons to stay sharp and last through the long haul of procedures. Companies like Acheron Instruments and Surgitronix really stand out for putting effort into crafting tools that meet surgical needs but also promote a more ergonomic experience—ultimately making life easier for the surgeons.

And you know, there are also some neat strategies out there, like the TULIPS mnemonic, that can really up the ergonomics game in the OR. By carefully arranging equipment and keeping the surgical space organized, surgeons can dodge those unnecessary movements and tricky poses. This not only keeps them safe from injuries but can also lead to better outcomes for patients. It’s clear that ergonomics is key in today’s surgical practices.

Cost vs. Quality: Making Budget-Friendly Choices for Laparoscopy

Choosing the right laparoscopic instruments for your surgeries can feel a bit like walking a tightrope, especially when you’re juggling cost and quality. For healthcare pros and clinics, sticking to a budget isn't always a walk in the park—especially when you need those tools to be reliable and effective. But don't worry, there are plenty of ways to make smart choices without sacrificing quality. If you take the time to dig into your options and pick vendors who balance affordability with durability, you'll be able to outfit your practice with essential tools that won’t leave your wallet gasping for air.

Nowadays, you've got a ton of choices out there that fit all sorts of budgets. Lots of manufacturers are stepping up, offering top-notch laparoscopic instruments at prices that won't make your head spin, which makes it way easier for clinics to find what they need without breaking the bank. It’s a good idea to seek out suppliers who promise not just quality, but also great customer service. And remember, affordable solutions don’t stop at instruments; they also include services that can speed up access to surgical procedures. Places like Charlottetown are rolling out cost-effective weight loss surgery options, so patients can get the care they need without those long waits.

By using modern buying strategies and snagging promotional deals, medical professionals can focus on getting the best bang for their buck while still ensuring top-notch surgical quality. Investing in the right laparoscopic tools isn’t just about how much you spend upfront; it’s really about securing successful outcomes for your patients and looking out for their overall health—all while keeping an eye on the budget.

Keeping Your Laparoscopic Instruments Sterile: Best Practices

Alright, so let’s talk about laparoscopic surgery for a minute. One of the biggest deals here is keeping those instruments sterile. I mean, we’re dealing with surgical sites that can easily get infected, right? If anything goes wrong with the sterile barrier, it can lead to some pretty serious complications. That’s why it’s super important to stick to best practices when it comes to keeping those laparoscopic tools nice and clean.

First off, right after you use them, it’s crucial to clean the instruments properly. Give them a good rinse to wash away any blood or debris, and then scrub them down with the right detergents. We really want to make sure there are no contaminants hanging around.

Once they’re all spick and span, how you store them matters just as much. You gotta put those instruments in sterilization trays that fit the steam or gas sterilization process. It's important to use the right kind of packaging, too. It should let steam in while keeping any potential nasties out. After they’ve been sterilized, store them in a dry and clean place until they're needed again. And hey, don’t forget to check them regularly for any signs of damage or wear—compromised instruments are a no-go if we want to maintain sterility.

Also, setting some solid protocols for how staff handles these instruments can really boost sterile practices across the board. Everyone should be trained in aseptic techniques so they know exactly how to handle and transport instruments without messing up their sterility. By keeping these best practices front and center, healthcare pros can really cut down on infection risks and help boost patient outcomes in laparoscopic surgeries.

Choosing the Right Supplier for Your Surgical Instrument Needs

When it comes to picking surgical instruments, the supplier you go with really matters for making sure the equipment is both top-notch and reliable. You know, a report from on the Global Surgical Instruments Market points out that there's been a big jump in demand for high-quality laparoscopic tools. This boom is largely thanks to the growth of minimally invasive surgeries. So, for healthcare pros looking to boost patient outcomes and streamline operations, selecting the right supplier is super important.

A solid supplier should be able to offer instruments that meet strict industry standards and regulations. The folks at the Association for the Advancement of Medical Instrumentation (AAMI) highlight that complying with ISO standards is key for manufacturers to keep that consistent quality in medical devices. This is especially critical in the laparoscopic arena, where precision tools like graspers, scissors, and electrosurgical devices need to work reliably under all sorts of conditions.

Plus, a trustworthy supplier should provide all-around support, which includes proper training for surgical staff and ongoing maintenance. A survey from showed that 78% of surgeons really prioritize suppliers who give clear guidance on how to operate and care for instruments. This kind of partnership can actually lead to fewer instrument failures and better surgical outcomes. It just goes to show how essential it is for healthcare providers to look beyond just the fancy products and consider the level of support and service a supplier brings to the table.

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Prosthetic Feet: Choosing the Right One

The journey of laparoscopy, which is now reaching single-incision and robotic surgery, began with our quest to find ways to reduce operative morbidity. Since those first steps were taken, gynaecological surgery with the use of minimally invasive techniques continues to change rapidly. With computerised design and microchip-controlled safety features, the laparoscopic surgeon is dependent on the equipment and needs to understand the electromechanical function of the instruments. In this changing environment, it is vital to understand the characteristics of the commonly used surgical instruments. The basic equipment essential for any laparoendoscopic procedure includes: endoscope, camera, light source, video monitor, insufflator, trocars and surgical instruments. However, there are many variants of each available.

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 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. 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.

Trocars/cannulas

These are used to create small passageways through the abdominal wall and are available in different textures (see Figure 1). Disposable and reusable trocars in various sizes are available and share the following common parts:

• Sharp tips cut an entry path through the abdominal wall while blunt tips stretch the tissues apart to gain access to the peritoneal cavity.
• Sleeve: is the working channel. Trocar sleeves or collars can have textures on the outer surface of the trocar that help it anchor to the abdominal wall. Some have an internal inflatable balloon at their tip and plastic/rubber ring to provide anchorage.
• Valve: different valve systems prevent gas leaking from trocars and allow the insertion of instruments.
• Side port: many trocars come with a side port that allows for gas insufflation or smoke evacuation.

Laparoscopes

The telescopes used in laparoscopy are available in sizes ranging from 2mm up to 12mm. The 10mm size is the one most commonly used in gynaecology. Similar to a hysteroscope, a laparoscope can come with an angle of view such as 0˚, 30˚ or 45˚. In an angled-view scope, the direction of vision points away from light source attachment. The 0˚ telescope offers a forward view corresponding to the natural approach and is preferred by most gynaecologists. It is useful if a less-experienced assistant is available. The 30˚ telescope can be rotated to enlarge field of view and can be advantageous for complicated cases. The 45˚ telescope is useful in single-incision laparoscopies, but is not commonly available. Every laparoscope has an engraved number by the eyepiece that specifies the viewing angle.

Instrument dimensions

The commonest diameter for laparoscopic instruments is 5mm, though they range from 2–12mm. The narrower diameter (less than 5mm) instruments have less shaft rigidity and therefore are more flexible and more fragile than the wider versions. Standard instruments’ length ranges from 34–37cm. In bariatric patients or for single-site laparoscopy, 45cm-long instruments are useful.

Non-energy devices

Most laparoscopic instruments offer only four degrees of freedom of movement: in/out, up/down, left/right and rotation. In addition, certain devices called articulating/roticulating instruments offer angulation at their tips, which can be particularly useful in achieving triangulation while performing single-incision laparoscopy.

Graspers and scissors usually have an insulated sheath, a central working device, a handle and a rotating capability at the working end.

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Ringed handles are similar to the conventional ring handle found on most needle holders used in open surgery. They can be in line or directed 90˚ in relation to the working axis. Some handles are in between these two:

• a pistol handle allows integration of several functions; and
• a co-axial handle is in the instrument axis.

The handles come with different types of ratchets that provide a locking mechanism.

Scissors with curved tips, analogous to Metzenbaum, are commonly used. Most endoscopic scissors can also be attached to the electrosurgical unit. Scissors are produced with variety of tips.

Grasper jaws (see Figure 2) are either are single action (one fixed jaw and one articulated jaw) or double action (both jaws articulated). Single-action jaws close with a stronger force ideally suited for an instrument such as a needle driver. Double action allows the jaws to open wider, so they are better suited as a dissection tool. Numerous grasper variants exist, with the inner side of the jaws having different surface properties, depending on the intended use:

• Traumatic: deep serrations or toothed tip for secure grasping.
• Atraumatic: finely serrated for gentle handling.

Equally, laparoscopic tenacula are also available with single-toothed and doubletoothed jaws.

Many styles of needle drivers are available and selection largely depends on surgeon’s preference. The jaws are either curved or straight. They commonly have a flat or finely serrated grasping surface, enabling them to grasp the needle in all directions. Certain needle-holders (termed self-righting) have a dome-shaped indentation inside their jaws that automatically orientates the needle in a perpendicular direction, thus making it easier to grasp the needle. However, if there is a need to load the needle at an oblique angle, the indentation can make it harder. The needle drivers also have various types of handles (such as finger grip, palm grip, pistol grip) as described previously.

Myoma screws are in the shape of a probe with a corkscrew tip. They are frequently used during myomectomy.

The suction irrigator is a multipurpose piece of equipment. Most use a trumpet valve but some have a sliding valve. The irrigation system can be powered by various mechanisms including pressure bag or a pump. Omentum, fallopian tube or bowel can get drawn into the suction probe and care must be taken to release the attached tissues gently.

The aspiration needle is a 16/22-gauge needle used for aspiration and injection of fluids.

There are two types of knot pushers available: the closed-end and the open-end knot pusher. Both have their advantages and disadvantages.

Energy devices

Energy sources include monopolar, bipolar, advanced bipolar, harmonic, combined and morcellator devices. Monopolar devices are commonly used in endometriosis resection and for incising the vaginal cuff during laparoscopic hysterectomy. Various types of monopolar hooks and spatula are available and most scissors have an attachment to connect monopolar lead.

Bipolar devices contain the continuous waveform electrical current between the jaws of the forceps and hence reduce the chances of damage to adjacent tissue. They achieve tissue sealing and haemostasis by thermal coagulation, though they lack the ability to cut. The classic bipolar device is the Kleppinger bipolar forceps. Several types of bipolar devices, many of them in form of graspers, are now available.

The surgical evolution of the energy devices, particularly with advanced bipolar features, has been the central point in exponential growth of laparoscopic procedures. The gain in popularity of these devices can be gauged by the fact that they are sometimes now used for open surgery and even vaginal surgery.

Bipolar devices (such as LigaSure™, Gyrus PKS™ and EnSeal®) provide haemostasis for vessels up to 7mm. They provide a low voltage, have an impedance-based feedback that modifies the energy delivered and tissue temperature is regulated to be below 100°C. The bipolar energy thus delivered denatures the collagen and elastin in vessel walls. Denatured tissue, tissue apposition and pressure seal the vessel walls in a process called coaptive coagulation. In comparison to the traditional bipolar instruments, these devices have reduced thermal spread, diminished charring and reduced sticking. However, some of these devices require a specialist electrosurgical unit and they are costly.

LigaSure (Covidien) provides a continuous bipolar waveform and has an integrated cutting mechanism. GyrusPK (Gyrus ACMI) delivers a pulsed bipolar waveform that allows tissue and device tip to cool during the energy off phase, but lacks the ability to cut. Enseal (Ethicon) has nanometre-sized conductive particles that direct the energy and control temperature between the jaws. Like LigaSure, it is multifunctional, with an I-Blade™ to cut the sealed tissue.

Harmonic devices have a piezoelectric crystal in their handpiece that converts the electrical energy into ultrasonic energy. This energy is delivered to the active blade at the tip of the instrument causing it to vibrate at 55 000Hz. The tip of the device cuts mechanically with a degree of collateral thermal coagulation used for haemostasis. There is no active current in the tissue. The advantage of harmonic devices is lower temperature (<80°C) as compared to other energy devices, hence reduced thermal spread and less charring. As a result of mechanical vibrations, in lower density tissue the intercellular water is vaporised at lower temperatures (<80°C) causing a ‘cavitation effect’ that can help in dissection by separating tissue layers. They are FDA approved for <5mm vessel sealing. Though harmonic devices operate at low temperatures, the active blade of the device becomes very hot and can remain so for some time. Care should be taken not to touch the vital structures with the jaws of the device for several seconds after activation.

Thunderbeat® (Olympus) combines both advanced bipolar electricity and ultrasonic energy in a single, multi-functional, handactivated instrument and can potentially reduce the surgical time.

Morcellators can be important tools for specimen removal during procedures, such as myomectomy, when a large amount of tissue is retrieved laparoscopically. Various types of morcellators are available on the market. The key safety maxim is to keep morcellator tip close to abdominal wall, to pull the tissue into the morcellator and not push the morcellator into the tissue. Morcellators require ports that are bigger than 5mm. Morcellation has recently been in news with a US Food and Drug Administration safety communication in swiftly followed by new and/or revised guidelines, including a joint statement by AGES and RANZCOG. To prevent tissue dissemination, power morcellation in an isolation bag has been proposed. Recently, an in-bag morcellation device (Alexis™ Contained Extraction System) has also been made available.