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S U R G I C A L
S M O K E
scope lenses, and multiple solutions.
Pre-warming and pre-treating the scope ahead of time simplifies the entry.
"We put it in a scope warmer, like a thermos full of warm water," says Dr.
Barrett, in order to lessen the temperature difference between the room-aircooled instrument and the pneumoperitoneum. There is also commercially
available anti-fog solution which, applied to the scope tip, can keep the lens
clear.
If mid-procedure defogging becomes necessary, one manufacturer offers a single-use, stable-based laparoscope holder that cleans, warms and anti-fog treats
the scope's tip upon insertion. Dr. Baxt says an instrument bath of warm saline
on the back table can deliver similar results. "Every OR's got sterile basins and
saline from the warmer," he says. "It's cheap and easy."
The way a surgery is set up can also reduce the likelihood of fog delays. An
insufflator that maintains the proper temperature and humidity during a case or
a smoke evacuator that pumps in warmed, humidified CO2 can help to prevent
mid-procedure fogging, says Dr. Baxt.
So can being mindful of the direction
of the insufflator or evacuator's airflow,
adds Dr. Barrett. "I typically make sure
that the air coming in isn't coming
through the same port as the scope is,
PORT OF ENTRY Instrument exchanges in midcase can smudge ports, and scope lenses.
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to minimize fog," he says.
Solve the smudges and smears
"The scope smears with blood, fat or slime," says Dr. Voeller.
"Depending on the case, you sometimes spend more time wiping the
scope than doing the procedure."
Applying a surfactant substance to the lens before a procedure can provide a
preliminary defense against a buildup of debris. In mid-procedure, cleaning
smudged lenses with a squirt of saline from the scope's irrigation channel or a
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