Laparoscopic lens fogging: a review of etiology and methods to maintain a clear visual field.

Laparoscopic surgical procedures are becoming common across surgical specialties, including urology. Maintaining a clear field of vision is paramount in such procedures not only for safety by preventing inadvertent injury, but also to improve precision and reduce operative time. Laparoscopic lens fogging (LLF) is a major impediment to a clear visual field during laparoscopy and is caused by condensation as well as particulate debris, blood, and smoke accumulation on the scope lens. Despite many available techniques to improve vision during laparoscopy, available data on etiology and methods to improve vision have only sporadically been considered in the literature. The objective of this review was to summarize current literature on the etiology of LLF and other causes of poor vision during laparoscopy and also review the current approaches for minimizing or reducing such events. In summary, although the etiology of LLF is well understood, that is, temperature and humidity differences, the methods to reduce its occurrence lack significant data. Of those methods that are often espoused, most are not supported in the literature, such as warmed and humidified insufflation gas, or simply lack data, such as antifogging solutions.