1. Laparoscopic Instruments & Tower 5 th Practice Department of Surgical Research and Techniques

2. Requirements: 1. Laparoscopic Tower – Parts and Functions 2. Usage of the Laparoscopic Instruments 3. Practice on the Pelvitrainer 5 th Practice Department of Surgical Research and Techniques

3. Laparoscopic Tower Diathermy (mono- and bipolar diathermy) Monitor Light source Camera control unit Insufflator Suction-irrigation system Video recorder Roller stand 5 th Practice Department of Surgical Research and Techniques

4. Pneumoperitoneum Lifting the abdominal wall by insufflation with carbon dioxide gas Department of Surgical Research and Techniques 5 th Practical

5. Veres needle Connection of insufflator tube Sharp outer cannula Spring-loaded inner stylet with a blunt tip Inlet for gas Proper handling position 5 th Practice Department of Surgical Research and Techniques

6. Insufflator Intraabdominal pressure (mmHg) Gas flow (liter/min) Amount of the used gas (liter) Antibacterial filter Disposable insufflator tubing Amount of gas in the gas- tank Power switch 5 th Practice Department of Surgical Research and Techniques

7. Trocars Outer diameter 5 mm -10 mm Inner cannula/ Sharp Valve Switch Outer cannula is blunt/ Port 5 th Practice Department of Surgical Research and Techniques

8. 5 th Practice Department of Surgical Research and Techniques

9. Safety Trocars Corkscrew trocarSharp and blunt shafts Spring-loaded plastic shield 5 th Practice Department of Surgical Research and Techniques

10. Trocar Insertion The first trocar is inserted blindly, usage of safety trocars is mandatory! 5 th Practice Department of Surgical Research and Techniques

11. Light Source Degree of brightness Brightness adjustmentFibre-optic cable Power switch 5 th Practice Department of Surgical Research and Techniques Check the light cable before use!

12. Telescopes Traditional & Hopkins Telescopes with rod lens and fibers optikai lencsék quartz rúd-lencse Length: 30 cm Diameter: 5 mm, 10 mm Degree: 0°, 30°, 45° 5 th Practice Department of Surgical Research and Techniques

13. Telescopes Objective lens (0° 30°45°) Light cable connection The field of view can be changed by the rotation of the light cable in 30 and 44 degree telescopes Camera 5 th Practice Department of Surgical Research and Techniques Ocular (camera connection)

14. Camera Controller Camera Power switch Camera plug in 5 th Practice Department of Surgical Research and Techniques

15. Telescope (bajonet) joint Programing /White balance Zoom ring Focus ring Cabel to the controller Camera Head 5 th Practice Department of Surgical Research and Techniques

16. Optical System Light Source Telescope Camera Camera Controller Video Cable Video Recorder Monitor Surgical Team 5 th Practice Department of Surgical Research and Techniques

17. Diathermy Controller 5 th Practice Department of Surgical Research and Techniques Double pedal footswitch Mono- & Bipolar diathermy Power switch Bipolar diathermy forceps Indifferent electrode pad

18. Diathermy 5 th Practice Department of Surgical Research and Techniques Forceps head Insulation + - Monopolar Hook+ Bipolar

19. Diathermy 5 th Practice Department of Surgical Research and Techniques Forceps head Insulation + - Monopolar Hook+ Bipolar Insulated & Non-insulated handles !

20. Suction (Hgmm) Irrigation (Hgmm) Sterile saline Collected bottle for aspirated materials Suction-Irrigation System Hand piece/ Shaft 5 th Practice Department of Surgical Research and Techniques

21. Suction-Irrigation System 5 th Practice Department of Surgical Research and Techniques Tubing Multiple perforationThree-channel tube

22. 5 th Practice Department of Surgical Research and Techniques Dissectors & Grasping forceps Biopsy forcepsRatchet Pistol-grip handle BabcockBowel Allis Parts: handle outer tube working insert

23. II. Instruments II. Metzenbaum scissors, Hook scissors, Biopsy forceps 5 th Practice Department of Surgical Research and Techniques

24. Clip applier Unifying Instruments Staplers 5 th Practice Department of Surgical Research and Techniques

25. Suturing Instruments Szabó-Berci needle holders Coaxial handle Parrot-Jaw needle holder Flamingo-Jaw assistant needle holder 5 th Practice Department of Surgical Research and Techniques

26. Some pictures of this lecture are presented by courtesy of Zoltán Szabó Ph.D. 5 th Practice Department of Surgical Research and Techniques

27.  Two dimensional approach and three dimensional activity  Eye-hand coordination  Feeling deepth  Coordinate use of dominant and nondominant hand  Lack of tactile sensation  Magnifient surgical territory – finer manipulation  Limitted movement  Unusual instruments Department of Surgical Research and Techniques 5 th Practice Department of Surgical Research and Techniques Difficulties of laparoscopic technique