Archive Abdominal Surgery 2014

Surgeons Can't Fix What They Can't See

Technology can improve the views of laparoscopic surgery.

Dmitry Oleynikov, MD, FACS


visualization-related challenges ROOM WITH A VIEW Laparoscopy is tough enough to perform, without additional visualization-related challenges.

Smoke, lens fogging, debris, lighting that's never perfect: too dark or too light, too bright or not bright enough. Add in the challenge of operating in tunnel vision and it's a wonder surgeons can see well enough to perform surgery at all. But they can, and perform it well, thanks in part to a few technologies that overcome the fundamental visualization limitations of laparoscopy.

1. Imaging upgrades
Laparoscopic instruments don't let surgeons "feel" the abdominal cavity. They can't determine if the anatomy they're manipulating is hard, soft or textured. You can tell the difference between a circle and square on a 2D picture, but can you tell the difference between a soft square and hard square? That's the sort of challenge surgeons face during laparoscopic cases, when the difference between healthy and unhealthy tissue is its physical properties. The laparoscopic surgeon's ability to operate hinges solely on how well he can see the minute details of anatomy.

The better the camera, the better the scope and light source, the better the picture. High-definition obviously improves a surgeon's view of intra-abdominal action, but is the technology the standard of care? Not necessarily.

Scopes with light sources of questionable quality and screens that force surgeons to work off analog images are still in use today, even with the availability of many high-def camera and lighting options designed to improve surgeons' views — not to mention super HD and 3D — that are light years ahead of older equipment. But not all facilities have invested in the latest imaging technology that gives surgeons clear, crisp views of surgery. If you haven't yet upgraded your ORs, it's time to reconsider doing so.

2. Lens protection
Laparoscope lenses that are blocked by surgical debris or condensation are an annoyance surgeons must often endure. Thankfully, there are countless systems designed to limit these common issues.

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