Since the first prototype of a laparoscopy device was created in 1929 by a German gastroenterologist named Heinz Kalk, the field of laparoscopy has advanced significantly. Later, John Ruddock, an American internist, promoted laparoscopy in the U.S. in the 1930s by praising its advantages over laparotomy.
With the development of technology, various methods and tools were created to improve the safety, diagnostic accuracy, and therapeutic success of laparoscopy procedures.
The next big advancement in laparoscopic surgery was the invention of robotic surgery. Owing to this technology, surgeons were able to perform complex operations that were beyond the scope of traditional laparoscopic tools and equipment. The robot-assisted surgery was more accurate and efficient as it offered the doctors a lot more discretion.
Robotic surgical advancements are currently changing the face of the world's healthcare system. The precision in complicated surgical procedures is currently being redefined by the dexterity in suturing with motion scaling aspects.
Figure 1 Robot assisted laparoscopy surgery
The utilization of robotic surgical tools is expanding, and with the advent of contemporary robotic platforms, particularly in the post-pandemic environment, this technology can successfully meet the continuously increasing demand in global tertiary care facilities.
For instance, regionally, Canada is one of the developed countries that is witnessing a significant rise in the demand for advanced robotic-assisted laparoscopy devices as the preference for laparoscopic surgeries over open surgeries increases among the population.
According to the BIS Research market report, the Canada laparoscopy devices market was valued at $392.1 million in 2021 and is anticipated to reach $865.6 million by 2031, witnessing a CAGR of 7.31% during the forecast period 2022-2031.
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Therefore, robot-assisted laparoscopy surgery is now strongly advised for individuals who have certain medical disorders because it is recognized as the gold standard of treatment for gynecological, gastric oncologic, cancer, and urological-prostate operations.
Let’s learn more about the technological advancements in surgical laparoscopy devices that are leading this progress in surgical procedures.
Technological Advancement in Laparoscopy Devices
The fundamental tools required for each laparoscopic procedure include uterine manipulators, Veress needles, laparoscopes, and trocars/cannulas. Although the available variations for each are numerous, here is a description of a few typical laparoscopic tools.
Figure 2 Laparoscopy instruments used in surgery
1. Uterine Manipulators: To make pelvic surgery and laparoscopic hysterectomy easier, a novel and reusable uterine manipulator is used. The contraption is weighted to maintain the uterus in an anteverted posture while facilitating simple access to the cul-de-sac. For tubal insufflation, it creates a tight seal by being spring-loaded.
The tool incorporates a sliding cervical plug that enables it to be inserted into the fundus to a depth of 15 cm for uterine manipulation during laparoscopic hysterectomy. It is calibrated in centimeters. Regardless of the depth of penetration, the spring-loading mechanism firmly secures the device to the cervical tenaculum and rotates it 180 degrees for usage in the retroverted uterus.
There are currently a number of sophisticated uterine manipulators on the market, including the Spackman, Cohen, Hulka, Valtchev, Pelosi, and Clearview (both from Cooper Surgical) (Endopath). While some are throwaway, others are reusable. The majority have a channel for chromotubation.
2. Veress Needle: During laparoscopic general surgery, the two most popular methods for entering the peritoneal cavity are the blind Veress needle/trocar insertion and the open trocar placement with direct visualization.
The Veress needle is a unique needle that is used to achieve pneumoperitoneum during closed laparoscopy. It has a blunt-tipped, spring-loaded inner stylet and a sharp outer needle. It comes in disposable and reusable varieties with lengths of 12 cm or 15 cm.
The majority of injuries in minimally invasive surgery are linked to primary port insertion, which causes a disagreement about the merits of different entrance procedures (open, closed, or direct entry). There is no proof that any one approach is superior to another in preventing serious vascular or visceral problems; however, a closed entrance has a larger chance of entry failure.
According to the most recent Cochrane analysis, using a direct entry rather than a Veress needle had a lower risk of vascular damage.
3. Trocars/Cannulas: These come in a variety of textures and are used to cut tiny holes through the abdominal wall. There are both disposable and reusable trocars in a range of sizes, and they all include the same basic components. A few features of the trocars are mentioned as follows:
• Blunt tips tear the tissues apart to get access to the peritoneal cavity, while sharp tips cut a route through the abdominal wall.
• The channel for working is the sleeve. Textures on the outside of trocar sleeves or collars may aid in the trocar's ability to cling to the abdominal wall. Some have a plastic or rubber ring for anchorage and an internal inflatable balloon at the tip.
• Various valve systems stop gas from trocars from leaking while enabling the insertion of instruments.
• Many trocars have a side port that enables the insufflation of gas or the expulsion of smoke.
4. Laparoscopes: A narrow, tube-like device called a laparoscope is used to examine the tissues and organs inside the abdomen. A laparoscope can feature an instrument to cut through tissue in addition to a light and lens for viewing.
The sizes of the telescopes used in laparoscopy range from 2mm to 12mm. The most popular size of laparoscopes used in gynecology is 10mm. A laparoscope, like a hysteroscope, can have a 0°, 30°, or 45° angle of view. The direction of vision in an angled-view scope is away from the attachment of the light source. Most gynecologists choose the 0° telescope because it provides a forward perspective similar to the natural method.
The 30° telescope has an expandable field of view and might be useful in challenging situations. Although it is not frequently accessible, the 45 telescope is useful for single-incision laparoscopies. By the eyepiece of each laparoscope is an etched number that indicates the viewing angle.
Existing minimally invasive surgery has its limitations, which can be overcome with the use of robotic-assisted laparoscopy instruments. The laparoscopy devices offer a better scope of surgical procedures with advanced tools such as surgical arms and advanced cameras for a better 3D perspective of the surgical area.
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