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Hand Instrumentations in

Laparoscopic Surgery

Training In Basic LaparoscopicTechniques

R.G. Kar Medical College & Hospital

Kolkata

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Disposable

Reusable Handle

Outer tube Insert

Size1.7mm to 12mm

Commonly used - 5mm / 10mm for regular use1.4 / 3mm for paediatric use

12mm - staplers

Laparoscopic Hand Instruments

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Usually very few needed for standard surgery

Work on fulcrumbest effect at centre

Usual length

33cm

Laparoscopic Hand Instruments

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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

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Handle Ring type

Radial

Inline

Pistol type

Wire bent type

Ball handled type

Laparoscopic Hand Instruments

Ideal handle

Good ergonomic design

Locking / unlocking Rotatable / non-rotatable

Diathermy attachment

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Laparoscopic Hand Instruments

Ring type

Grip opening 65 to 90mm

Ring size30mm / 24mm

Angle between shaft & handle105 to1500

Fore finger rotation

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Laparoscopic Hand Instruments

Coaxial / Inline type handle

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Laparoscopic Hand Instruments

Ball type (Cuschieri)

Pencil type (Cuschieri)

Angle between shaft & handle can bechanged

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Laparoscopic Hand Instruments

Pistol type

Wire bend

Ergonomically good

Difficult in more vertical situations

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Dissection & Grasping Instrument

Most important instruments Curved

Straight

Blunt Pointed

Toothed

Non-toothed

Single jaw action

Good for strong grasp like fundus of gall bladder

Double jaw action

Good for precision grasping / suturing etc

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Babcock

Bowel grasper

Other clamps

Dissection & Grasping Instrument

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Coagulation & Cutting Hooks

J type L type

Spatula

Ball

Scissors Single jaw

Double jaw

Curved

Straight

Hook

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Suction Irrigation

TRUMPET TYPE/TOGGLE TYPE

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Occlusion & Tissue Approximation

Devices

Clip applicators

Large

Medium large

Small

Staplers

Tacker

Port closure

Suturing instruments

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Clip Applicators

Single jaw action

Double jaw action

Curved

Straight Take apart

Disposable (preloaded)

Reusable

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Staplers

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Tacker

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Needle Holders

Grip types Coaxial handle

Pistol type

Ring handle

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Tip types Straight

Curved

Self righting

Needle Holders

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Ideal Needle Holder

One which suits you

Heavy handle with strong & tapering jaw

Coaxial handle

Pistol typeproblem in rotation especially when the angle with skinis more (suturing from epigastric port)

Locking type

Tiptapering with single moving jaw

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Assisting Grasper

Short straight rounded tip with minimum serration

Without ratchet

Some use Maryland

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Port Closure Device

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Retraction Devices

Fan retractor

Snake retractor

Nathansons retractor

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Devices for Energy Modality

Harmonic scalpel

Ligasure

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