Literature DB >> 19275865

A simple solution to lens fogging during robotic and laparoscopic surgery.

Ceana Nezhat1, Vadim Morozov.   

Abstract

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Year:  2008        PMID: 19275865      PMCID: PMC3016008     

Source DB:  PubMed          Journal:  JSLS        ISSN: 1086-8089            Impact factor:   2.172


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INTRODUCTION

One of the fundamental principles of safe and successful endoscopic procedures is an ability to maintain a clear operating field. Fogging of the laparoscopic lens, splatter of irrigation fluid, blood, and bodily fluids are among those factors that affect a surgeon's ability to maintain a clear operating field. We have routinely used FRED antifog solution (US Surgical, North Haven, CT), which consists of less than 15% isopropyl alcohol, 2% surfactant, and more than 85% water, during laparoscopic procedures.[1] We also use the Insuflow (Lexion Medical, St. Paul, MN) device. Insuflow is a single-use device that attaches to the outlet port of an insufflator and is designed to warm and humidify the gas stream prior to insufflation into the abdominal cavity to prevent drying of peritoneal surfaces and to improve recovery time.[2-4] The Insuflow device consists of a disposable filter heater/humidifier tubing set and a control module that houses the control and safety circuits for the system.[5] Gas from the insufflator flows into the Insuflow device, through the in-line filter, continues along the tube to enter the Insuflow device cassette that contains the heating element and humidification media. Maintaining clarity of the laparoscopic lens in robotic cases proves more difficult. The da Vinci system has 2 independent scopes, requiring double the amount of routine care in preventing fogging and maintaining cleanliness of the lenses. A bulky robotic camera makes removing and cleaning the lenses more challenging. High intensity lights, while providing excellent illumination of internal anatomy, preclude cleaning the lenses by touching the serosal surfaces due to potential serosal burn. The usual situation in the robotic OR is a condition where one “eye” is clean and the other is either fogged or “smudged,” requiring constant disengagement of the camera arm, prolonging operating time, and adding to frustration. The Insuflow device warms and humidifies CO2 gas that bathes both lenses and significantly decreases the amount of fogging when attached to a robotic camera cannula. We have developed a method of mixing 30 mL of sterile saline with 3 mL of FRED antifog solution. Injecting this mixture into the Insuflow chamber allows the delivery of warm, moistened CO2 gas admixed with an antifogging substance right to the tip of the robotic scopes, almost entirely eliminating the problem of lens fogging. Although this technique does not entirely eliminate the need to clean the scope, it does decrease this problem significantly. We have used this mixture in over 100 cases without any problems and have achieved good results.
  3 in total

1.  Model to determine resistance and leakage-dependent flow on flow performance of laparoscopic insufflators to predict gas flow rate of cannulas.

Authors:  V R Jacobs; J E Morrison; C Mundhenke; K Golombeck; W Jonat; D Harder
Journal:  J Am Assoc Gynecol Laparosc       Date:  2000-08

2.  A randomized controlled trial assessing the benefit of humidified insufflation gas during laparoscopic surgery.

Authors:  W G Mouton; J R Bessell; S H Millard; P S Baxter; G J Maddern
Journal:  Surg Endosc       Date:  1999-02       Impact factor: 4.584

3.  Reduction of laparoscopic-induced hypothermia, postoperative pain and recovery room length of stay by pre-conditioning gas with the Insuflow device: a prospective randomized controlled multi-center study.

Authors:  D E Ott; H Reich; B Love; R McCorvey; A Toledo; C Y Liu; R Syed; K Kumar
Journal:  JSLS       Date:  1998 Oct-Dec       Impact factor: 2.172

  3 in total
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Authors:  Bharat Gurnani; Kirandeep Kaur; Kapil Mishra; Rengaraj Venkatesh
Journal:  Indian J Ophthalmol       Date:  2020-08       Impact factor: 1.848

2.  Laparoscopic lens fogging: solving a common surgical problem in standard and robotic laparoscopes via a scientific model.

Authors:  Todd G Manning; Nathan Papa; Marlon Perera; Shannon McGrath; Daniel Christidis; Munad Khan; Richard O'Beirne; Nicholas Campbell; Damien Bolton; Nathan Lawrentschuk
Journal:  Surg Endosc       Date:  2017-08-08       Impact factor: 4.584

3.  Povidone-iodine surgical scrub solution prevents fogging of the scope's lens during laparoscopic surgery.

Authors:  Bijan Mohammadhosseini
Journal:  Surg Endosc       Date:  2010-06       Impact factor: 4.584

4.  Alternative agents to prevent fogging in head and neck endoscopy.

Authors:  Patorn Piromchai; Pornthep Kasemsiri; Sanguansak Thanaviratananich
Journal:  Clin Med Insights Ear Nose Throat       Date:  2011-01-10

5.  Quantifying Intraoperative Laparoscopic Visual Field Opacity.

Authors:  Danielle Abbitt; Bertha Ben Khallouq; Jay Redan
Journal:  JSLS       Date:  2017 Apr-Jun       Impact factor: 2.172

6.  Comparison of three low-cost techniques to control fogging of sealed eyewear in a simulated operating room environment: A preliminary analysis.

Authors:  Arvind Kumar; Owais Ahmed Qureshi; Rajesh Arora; Sandeep Kumar; Javed Jameel; Rizwan Khan
Journal:  J Clin Orthop Trauma       Date:  2020-07-17

7.  Effective cleaning of endoscopic lenses to achieve visual clarity for minimally invasive abdominopelvic surgery: a systematic review.

Authors:  Ahmad Nabeel; Salman K Al-Sabah; Hutan Ashrafian
Journal:  Surg Endosc       Date:  2021-05-07       Impact factor: 4.584

  7 in total

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