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Hand Instrumentations in Laparoscopic Surgery

Training In Basic Laparoscopic Techniques R.G. Kar Medical College & Hospital Kolkata

Laparoscopic Hand Instruments

Disposable Reusable
Handle Outer tube Insert

Size 1.7mm to 12mm Commonly used - 5mm / 10mm for regular use
1.4 / 3mm for paediatric use 12mm - staplers

Laparoscopic Hand Instruments

Usually very few needed for standard surgery


Work on fulcrum best effect at centre Usual length 33cm

Laparoscopic Hand Instruments


Ideal Hand Instrument

Ergonomically suitable handle Sturdy & stable when jaws are activated Less trauma to tissue Take apart

Easy to clean & sterilize Parts interchangeable

Insulation easily replaceable Simple design with minimum no. of hinges / crevices

Laparoscopic Hand Instruments

Handle

Ring type
Radial Inline

Ideal handle Good ergonomic design Locking / unlocking Rotatable / non-rotatable Diathermy attachment

Pistol type Wire bent type Ball handled type

Laparoscopic Hand Instruments

Ring type

Grip opening 65 to 90mm Ring size 30mm / 24mm Angle between shaft & handle 105 to 1500 Fore finger rotation

Laparoscopic Hand Instruments

Coaxial / Inline type handle

Laparoscopic Hand Instruments

Ball type (Cuschieri)

Pencil type (Cuschieri)

Angle between shaft & handle can be changed

Laparoscopic Hand Instruments

Pistol type

Wire bend

Ergonomically good Difficult in more vertical situations

Dissection & Grasping Instrument


Most important instruments Curved Straight


Blunt Pointed

Toothed Non-toothed
Good for strong grasp like fundus of gall bladder

Single jaw action


Double jaw action Good for precision grasping / suturing etc

Dissection & Grasping Instrument

Babcock Bowel grasper Other clamps

Coagulation & Cutting

Hooks

J type L type

Spatula

Ball
Scissors

Single jaw Double jaw Curved Straight Hook

Suction Irrigation

TRUMPET TYPE/TOGGLE TYPE

Occlusion & Tissue Approximation Devices

Clip applicators

Large Medium large Small

Staplers Tacker Port closure Suturing instruments

Clip Applicators
Single jaw action Double jaw action Curved Straight Take apart Disposable (preloaded) Reusable

Staplers

Tacker

Needle Holders

Grip types
Coaxial handle Pistol type Ring handle

Needle Holders

Tip types
Straight Curved Self righting

Ideal Needle Holder

One which suits you Heavy handle with strong & tapering jaw Coaxial handle

Pistol type problem in rotation especially when the angle with skin is more (suturing from epigastric port)

Locking type Tip tapering with single moving jaw

Assisting Grasper

Short straight rounded tip with minimum serration Without ratchet

Some use Maryland

Port Closure Device

Retraction Devices

Fan retractor

Snake retractor

Nathansons retractor

Devices for Energy Modality

Harmonic scalpel

Ligasure

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