through failed to impress Vedra A. Augenstein, MD, a general surgeon
in the Carolinas HealthCare System in Charlotte, N.C., during a trial.
"Once you get inside the abdomen, that's where lenses are impacted by
condensation and spray during cauterization," she says. "Investing in
something that doesn't do a perfect job of keeping the lens clear might
not be worth it." She, too, often relies on the tried-and-true methods of
removing the scope for cleaning or dabbing the lens against the
abdominal wall to remove gunk. Dr. Oleynikov kiddingly wishes for a
tiny wiper blade that whisks away the debris that sticks to the laparo-
scope's lens.
Part of the routine
Keeping views of laparoscopy clear has diagnostic value: Surgeons
can notice atypical lesions, and color variations and subtle pathology
in tissue, says Ceana Nezhat, MD, FACOG, FACS, of the Atlanta (Ga.)
Center for Special Minimally Invasive Surgery & Reproductive
Medicine.
"It's ideal to work with a stain-resistant laparoscope lens, an insuf-
flator that warms and humidifies gas, and an automatic smoke evacu-
ation device," says Dr. Nezhat. "The technologies add to the efficiency,
efficacy and safety of procedures."
Dr. Nezhat says ensuring pristine views of the surgical field is "as
important as proper patient positioning and appropriate skin prep-
ping," he says. "We check each day and before every case to ensure
the scope's integrity is intact and the camera is properly balanced."
His techs and assistants set up and check the equipment before
cases, but he reviews their work and takes full responsibility to
ensure every device is in good working order.
"I would not attempt laparoscopy unless all the equipment is primed
to provide me with optimal images," he adds. "It's part of my routine,
and it should be part of every surgeon's routine." OSM
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E-mail dcook@outpatientsurgery.net.
