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solution. Additional options include specially designed trocars that clean lenses
as they pass through and a barrier system that fits over the tips of laparoscopes
to keep lenses free of debris and clear of condensation.
Surgeons must also focus on keeping the lens clean when maneuvering inside
the abdomen. Once the lens gets dirty or fogs, the only truly effective way to
proceed is to remove it, clean it and put it back in, which is a time-wasting
annoyance.
3. Smoke-screen solutions
Attempting to see through the smoke generated during abdominal cases is
another inherent problem of laparoscopy. There are a number of different
ways to rid the surgical cavity of smoke. The easy way: Venting it through a
port. The practice works well, but if the CO
2
that's pumped back into the
abdominal cavity to maintain insufflation after venting is cold, the laparo-
scope's lens will likely fog. Units that warm the CO
2
delivered to the abdomi-
nal cavity are helpful in these situations.
Smoke evacuation technologies work well, but perhaps not substantially bet-
ter than focusing on not creating excessive smoke in the first place and occa-
sionally venting the smoke that is produced. In my opinion, the best way to
avoid smoke-related problems is to make less of it. New energy sources pro-
duce less smoke relative to cautery that was in widespread use just 10 years
ago.
4. Tissue manipulation
Trocars inserted to approximately 5mm are the standard small trocar used on
adults. However, mini-lap instruments designed for use through ports 3mm or
smaller, or perhaps no port at all in the case of needlescopic instruments, are well-
utilized in pediatric patients or during a single-incision surgery such as gall-bladder
removal. When maneuvering instruments through a single port, surgeons often
don't have an easy way to manipulate the gall bladder. Needlescopic graspers can
be inserted without a port and used to grasp the gall bladder and move it around.
B E T T E R V I E W S
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