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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 1  |  Issue : 1  |  Page : 17-19

Laparoscopic port cleaning: A technique for better visualization


Department of Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia

Date of Web Publication25-Oct-2016

Correspondence Address:
A Aldohayan
Department of Surgery, College of Medicine, King Saud University, P. O. Box 2925, Riyadh 11461
Kingdom of Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2542-4629.193041

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  Abstract 

Introduction: Laparoscopic approach had enormously advanced the surgical intervention. Such advancement had its own difficulties. One of this is the visualizations of internal structures by the endoscopic camera. Camera lens condensation or contamination by blood and/or fat obscures such view.
Materials and Surgical Technique: Here, we present an additional technique in which the use of sterile surgical strips by its specific absorptive and availability in different widths and lengths to clean the endoscopic entry ports with special focus over 5 mm ports that can be combined to the other well-known anticondensation methods for the overall better visualization.
Discussion: Different modalities to clean laparoscopic entry ports have been described but with difficulties and associated risks and limitations. The use of sterile packing strips in cleaning laparoscopic ports avoids the disadvantages descried in other modalities and in the same time being easy, adjustable, and have low cost.

Keywords: Contamination; laparoscopic; lens


How to cite this article:
Aldohayan A, Alshomer F, Alnaami M, Alobeed O, Bamehriz F. Laparoscopic port cleaning: A technique for better visualization. Saudi J Laparosc 2016;1:17-9

How to cite this URL:
Aldohayan A, Alshomer F, Alnaami M, Alobeed O, Bamehriz F. Laparoscopic port cleaning: A technique for better visualization. Saudi J Laparosc [serial online] 2016 [cited 2019 Mar 26];1:17-9. Available from: http://www.saudijl.org/text.asp?2016/1/1/17/193041


  Introduction Top


Laparoscopic modalities have advanced the surgical techniques quite enormously; however, such advancement is not free of difficulties and/or complication. [1]

One of these difficulties resides in the clarity of visualization through the different accesses optioned that inability to obtain a clear view might affect the overall surgeon's effort, risk of associated complications as well as time consumed. [2],[3] Lens camera condensation or contamination can cause such an obstacle. Various methods have been described that addresses the problem of camera condensation. [4],[5],[6] Few reports in the other hand have discussed the issue of lens contamination either directly or indirectly through the entry port and methods to prevent it. [7],[8]

This article presents a new technique from King Khalid University Hospital, College of Medicine at King Saud University in Riyadh, Saudi Arabia, that is a center of excellence in laparoscopic surgery since 1991 AD, [9],[10],[11],[12] in which it addresses the cleaning of the entry ports whichever the size and/or length that deals with lens contamination and can be an add-on to the various anticondensation methods to promote clarity and ease of such access.


  Materials and Surgical Technique Top


Laparoscopic port contamination with blood or fat obscures the camera view of internal structures. Different port sizes are used in which a corresponding camera with appropriate size will be inserted through. This method describes the use of sterile packing strips (Derma Pak-Its; Derma sciences® ) usually used in wound management due to its high absorptive profile in cleaning such ports. The use of sterile packing strips can be adjusted to whichever port size and/or length. It can be used to clean 3, 5, 10, 12, and 15 mm ports easily depending on the strip width being used. It can also clean 100-150 mm ports depending on the length of the strip used. The strip is held and introduced through the port by various graspers that with circumferential and repeated in/out movement will clean the port. For 5-mm ports, the use of 0.5-inch width sterile packing strips held using 2 mm endoscopic grasper (Autosuture® , Covidien® ) is applied [Figure 1]. For procedures that involve the use of two or more 5 mm ports, this technique can be applied as well as for simultaneous cleaning process in which the sterile packing strip will be lengthier enough, and while been held by the clamp, it will be passed from one port from outside to inside and then from inside to outside through another port again with serial in/out movement and later on removal through the exit port [Figure 2]. This also can be applied to different port sizes, and lengths either single or multiports been used by adjusting the width and/or length of the strip. Sterile packing strips are available in different width, and each package contains on average 5 yards (4.5 m) length.
Figure 1: The general assembly of the sterile packing strips held by 2 mm endoscopic grasper. Also the technique applied to either single and/or multiple ports whichever the length

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Figure 2: The way sterile packing strips are introduced through the laparoscopic port, either single port or multiple ports simultaneously

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  Discussion Top


The use of sterile packing strips to ensure proper cleaning of the laparoscopic port, and the whole length of the trocar is easy and reproducible. Other modalities are unnecessary with the use of this technique before the insertion of the camera whichever the port specifications were. Adjusting the width as well as the length of the packing strips according to the dedicated port to be cleaned is the essence of this technique.

Cleaning of the laparoscopic entry port and the camera lens together with preventing camera condensation has its impact on the overall surgical intervention. The aim of whichever modality delivered to ensure cleanliness should be easy, available, feasible, and not time-consuming. Cleaning of the port has its impact on the associated lens clarity after being inserted. Among the methods described to clean the ports, a work by Theeuwes et al. [8] in which three reusable methods were described that are mostly directed toward cleaning 10-12 mm ports. The first method is with the use of tightly wrapped sterile gauze over an endoscopic clamp, the second with the use of tightly wrapped sterile gauze over Pean clamp, and finally, the third with the use of sterile 10 mm cotton swab. Each of these modalities was associated with certain limitations such as limited port size and length applicability, risk of falling, and chances to be lost within the abdominal cavity.

On the other hand, Alhamdani et al. [7] they described another technique in which cleaning of 5 mm ports was applied using culture swab stick with serial repeated in/out movement to clean the port. Such modality also has its own limitations in which limited length of the swab stick will not be able to cover the whole surface area of long ports, together with the fact that some swab sticks are cap free, so it has a risk of falling and being lost in the abdominal cavity.

In contrast to our technique, the use of sterile packing strips in which the strip used is held in place by an endo-grasper and by repeated in and out together with circumferential movements will help in cleaning the port and the whole length of the trocar. This technique can be adjusted for various port sizes and/or lengths together with its different ways of application as described. The use of this modality has the advantages of being adaptable, repeatable, easy to use, sterile, low cost, and not time-consuming.


  Conclusion Top


The use of sterile packing strips in cleaning laparoscopic ports is a dynamic and adjustable modality that can be used to clean such access points in which clear visualization is a necessity. It can avoid the disadvantages descried in other modalities and in the same time being reusable, adjustable, and have low cost.

Acknowledgments

  • Thanks to the College of Medicine Research Center, Deanship of Scientific Research, King Saud University, Saudi Arabia, for the help in literature access and material organization
  • There were no sources. We have nothing to disclose with regard to conflict of interests or source of funding.
Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Karthik S, Augustine AJ, Shibumon MM, Pai MV. Analysis of laparoscopic port site complications: A descriptive study. J Minim Access Surg 2013;9:59-64.  Back to cited text no. 1
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2.
Lawrentschuk N, Fleshner NE, Bolton DM. Laparoscopic lens fogging: A review of etiology and methods to maintain a clear visual field. J Endourol 2010;24:905-13.  Back to cited text no. 2
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3.
Yong N, Grange P, Eldred-Evans D. Impact of Laparoscopic Lens Contamination in Operating Theaters: A Study on the Frequency and Duration of Lens Contamination and Commonly Utilized Techniques to Maintain Clear Vision. Surg Laparosc Endosc Percutan Tech. 2016;26:286-9.  Back to cited text no. 3
    
4.
Mohammadhosseini B. Povidone-iodine surgical scrub solution prevents fogging of the scope's lens during laparoscopic surgery. Surg Endosc 2010;24:1498-9.  Back to cited text no. 4
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5.
Runia AJ, Zengerink JF, Mannaerts GH. Easy cleaning of the scope's lens in a syringe to prevent condensation during laparoscopic surgery. Surg Endosc 2009;23:2849-50.  Back to cited text no. 5
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6.
Van Deurzen DF, Mannaerts GH, Jakimowicz JJ, Cuschieri A. Prevention of lens condensation in laparoscopic surgery by lens heating with a thermos flask. Surg Endosc 2005;19:299-300.  Back to cited text no. 6
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7.
Alhamdani A, Abbas A, Mahmud S, Baker A. Cleaning the laparoscopic camera port by a microbiology culture swab. J Laparoendosc Adv Surg Tech A 2008;18:751-2.  Back to cited text no. 7
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8.
Theeuwes H, Zengerink H, Mannaerts G. Easy cleaning of the camera port during laparoscopic surgery: Three practical techniques. J Laparoendosc Adv Surg Tech A 2011;21:821-2.  Back to cited text no. 8
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9.
Al-Dohayan A. Laparoscopic placement of peritoneal dialysis catheter (same day dialysis). JSLS 1999;3:327-9.  Back to cited text no. 9
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El-Dawlatly AA, Al-Dohayan A, Abdel-Meguid ME, El-Bakry A, Manaa EM. The effects of pneumoperitoneum on respiratory mechanics during general anesthesia for bariatric surgery. Obes Surg 2004;14:212-5.  Back to cited text no. 10
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Khairy G, Al Ghumlas A, Al Dohayan A, Gader AG. Haemostatic changes in laparoscopic cholecystectomy: A comparison between upper and lower limb measurements. Surg Laparosc Endosc Percutan Tech 2010;20:79-83.  Back to cited text no. 11
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Al-Naami M, Anjum MN, Aldohayan A, Al-Khayal K, Alkharji H. Robotic general surgery experience: A gradual progress from simple to more complex procedures. Int J Med Robot 2013;9:486-91.  Back to cited text no. 12
[PUBMED]    


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