Let us start with the question, if instruments make good surgeon? Instruments and apparatuses for laparoscopic hysterectomies have been developed over the last 40 years for interventions with multiple ports as well as for single-port surgery. A good surgeon bases his surgical plan on his knowledge of anatomy, recognizing the presented disease, his intuitiveness, and on optimal instruments and coagulation systems. With this issue, we are dealing in three parts: 1. History 2. General systems for adhesion prevention, mesh, stitching and knotting techniques, staples, glue, drains, rinsing solutions, and suction 3. Instruments and apparatuses for laparoscopic hysterectomies
Instrument trolleys gather all equipment used in gynecological and general laparoscopic surgery. These smart carts are available as rolling carts or on special platforms hanging down from the ceiling. Operating room settings, like OR1TM Neo (Karl Storz GmbH, Tuttlingen, Germany) or the Endoalpha or Visera Elite of Olympus or the Stryker unit with SDC Ultra as digital documentation system, form the basis to position the necessary equipment for easy use of the surgeon.
The idea of warming and humidifying the CO2 gas to avoid peritoneal damage has been well described by Philippe Konincks and Douglas Ott. The HumiGardTM of Fisher and Paykel Health care (Auckland, New Zealand) provides heated, filtered, and humidified gas for abdominal insufflation with a predetermined temperature.
Today, every CO2 pneu automatic provides up to 37°C heated CO2 gas, which is controlled by a pressure regulator within the machine by applying the Quatro-test. In the Quatrotest, the volume of gas flowing through the Veress needle during insufflation, intra-abdominal pressure, total volume, and preset filling pressure are measured. Cold light provided by xenon lamps is already substituted by light-emitting diode light. Video camera setup with three-chip cameras is substituted recently by HC camera systems and can be used for laparoscopy as well as in hysteroscopy. High-resolution video with video monitors guarantees optimal picture quality. The technological development allows the use of larger monitors in high-definition quality that facilitates a relaxed working atmosphere for the surgeon.
A realistic, nearly true to life three-dimensional (3D) picture is possible due to various technological elements, such as digital simulation, a second camera system, or the use of shutter lens. Digital devices for the video camera control the picture quality and facilitate automatic white balancing. The Karl Storz Company already offers the TRICAM 3D imaging system that allows the surgeon to view crisp, clear image through a pair of lightweight polarizing glasses. The ENDOCAMELEON laparoscope provides a viewing angle that can be adjusted continuously between 0 and 120.