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Summary
Of course, laparoscopic standard instruments can always be used for individual port surgery and can often be used together with specialized single port instruments. Fixed direct instruments offer a full intensity advantage and therefore transmit a functional force and drawback consistently. For many simple procedures as direct epidemiological instruments are often needed.
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Instrumentation and Endoscopy Systems
The cornerstones of traditional laparoscopic surgery are triangulation and withdrawal, which are removed at distant ports. No port surgery has this option and therefore two different techniques are used for their success. The first uses standard direct instruments crossing at the point of entry, resulting in the right hand operating the instrument on the left. The latter involves the use of flexible, risky or curved instruments.
The location of optimal instruments allows for the withdrawal of correct tissue, which is essential for effective dissection in anatomical tissue planes. By adding a number of parallel instruments, as required in individual port surgery, this is much more difficult. The use of at least one flexible or curved instrument can adjust the angle enough to allow enhanced triangulation; however, this usually requires the surgical instruments of the surgeon, which requires reciprocating external movements. This can lead to external congestion of the instruments, and should be expected to close and allow instruments, particularly during training in these procedures.
External congestion can be a problem when the hands of the surgeon and the assistant are in the same space. This is inevitable when standard direct instruments are used with bulky handles and laparoscope just with light lead at 90 degrees on the scope and one bulky camera. The camera systems and instruments can be used with a combination of standard reusable equipment to minimize expenditure.
Instruments
Laparoscopic Surgical Instruments
These use technology that uses laparoscopic instruments that allow the prompts to be rectangular relative to the shaft and to provide the means of passing instruments through one port location. The Dissect Endo are a standard diathermy and bubble; Endo Mini-Shears with unipolar diathermy; and Endo Grasp with a spin lock; instruments are 5 mm long 5 cm long.
Laparoscopic Endo Trainer
Camera chip is remotely installed at Endo Trainer’s camera system with a streamlined light cable rather than the standard laparoscopic light cable that enters the lens at 90 °.
This hinders the bulk of the camera and thus reduces the existing collision. These instruments are available in 5 mm and 10 mm versions with directions 0 °, 30 ° or 45 ° and in two different lengths to accommodate more patients.
They are also available with a detectable crop that allows the target site to be viewed from many angles. Flexible top 10 mm scope is already available and flexible 5 mm scope is awaited but may not be suitable for autoimaging.
An externally flexible 10 mm laparoscope was also used which gives out the hands of the assistant at least.
The main advantage of a digital system is that the camera chip is close to the surgical area and therefore a longer flexible grading does not degrade the quality of the pictures.
Cameras and endoscopes
With camera system fixing for individual port surgery the following characteristics are advantageous. Firstly, the scope of 5 mm diameter takes less space in the port requiring a smaller incision and leaves a 10–12 mm free port for larger instruments e.g. endoscopic stapling devices to be replicated. Avoiding separate light exterior lead gives more space to work externally and avoids the camera by operating the instruments. Scope with a scenic area of 30 degrees gives the axis more space internally and externally but has flexible fiber scope that allows ideal scenic variable angle. If internally flexible scope is not available, then externally flexible scope will apply from the assistant’s hands from the surgeon’s field. Integrated digital cameras also reduce external bulk and provide more space. Flexible, endoscopies are not fully automated and therefore cannot be used. They may not maintain a position as desirable as possible, nor do they give the best optical sight.
Future possibilities include NOTE (Natural Transboundary Endoscopic Surgery) equipment such as a flexible endoscope with integrated diathermy work channels or systems or withdrawal or wireless camera systems such as an internally installed capsule product used with a magnet externally.
The following is a list of camera systems that differ from traditional standard laparoscopes that offer some advantages for individual port surgery.
Future instrumentation
While there have been a number of developments in laparoscopic instruments to improve individual port surgery, there is still potential for further improvements. Despite the recently introduced bending and flexible instruments, change remains a major issue. Motor instruments may be a solution to this problem. Extracorporeal congestion is certainly reduced as a result of instrumentation with polished, low profile handles.
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