Laparoscopic lens fogging: solving a common surgical problem in standard and robotic laparoscopes via a scientific model

Early Experience With a Novel Super-Hydrophilic Laparoscopic Scope Cleaning Device and Narrative Review of Available Cleaning Strategies

BACKGROUND

Impaired visibility is a challenge in laparoscopic surgery. Frequent scope removal increases operative time, reduces efficiency, and potentially compromises patient safety. We examine our initial experience with a novel cleaning device that applies cold plasma to the scope lens and review current available laparoscope cleaning methods.

METHODS

The novel device was used in a variety of laparoscopic general surgery cases from April to November 2023. Primary outcome was number of scope removals per case. Secondary outcomes were time spent cleaning and number of times the scope became smudged or dirty with blood/tissue debris (debris events). An existing device that utilizes heated anti-fogging solution was used for comparison.

RESULTS

97 cases were included (31 with novel device and 66 with existing device). Scope removal rate for the novel device was lower compared to the existing device (0.87 ± 1.02 vs 0.97 ± 1.20 removals/case, P = 0.69), but not statistically significant. Average number of debris events was also lower for the novel device, but not statistically significant (0.90 ± 0.94 vs 1.0 ± 1.18 debris events/case, P = 0.69). Average total time spent cleaning per case was similar between devices (16.9 ± 24.0 vs 15.9 ± 18.7 seconds, P = 0.82).

CONCLUSION

This study demonstrates that a hydrophilic scope cleaning device has comparable performance to heated anti-fogging solution and may reduce scope removals and debris events. Direct comparisons between cleaning products are lacking. Surgeons are most likely to be successful with the cleaning strategy that best suits one's surgical practice.

Routine Automated Assessment Using Surgical Intelligence Reveals Substantial Time Spent Outside the Patient's Body in Minimally Invasive Gynecological Surgeries

OBJECTIVE

To demonstrate the use of surgical intelligence to routinely and automatically assess the proportion of time spent outside of the patient's body (out-of-body-OOB) in laparoscopic gynecological procedures, as a potential basis for clinical and efficiency-related insights.

DESIGN

A retrospective analysis of videos of laparoscopic gynecological procedures.

SETTING

Two operating rooms at the Gynecology Department of a tertiary medical center.

PARTICIPANTS

All patients who underwent laparoscopic gynecological procedures between January 1, 2021 and December 31, 2022 in those two rooms.

INTERVENTIONS

A surgical intelligence platform installed in the two rooms routinely captured and analyzed surgical video, using AI to identify and document procedure duration and the amount and percentage of time that the laparoscope was withdrawn from the patient's body per procedure.

RESULTS

A total of 634 surgical videos were included in the final dataset. The cumulative time for all procedures was 639 hours, of which 48 hours (7.5%) were OOB segments. Average OOB percentage was 8.7% (SD = 8.7%) for all the procedures and differed significantly between procedure types (p < .001), with unilateral and bilateral salpingo-oophorectomies showing the highest percentages at 15.6% (SD = 13.3%) and 13.3% (SD = 11.3%), respectively. Hysterectomy and myomectomy, which do not require the endoscope to be removed for specimen extraction, showed a lower percentage (mean = 4.2%, SD = 5.2%) than the other procedures (mean = 11.1%, SD = 9.3%; p < .001). Percentages were lower when the operating team included a senior surgeon (mean = 8.4%, standard deviation = 9.2%) than when it did not (mean = 10.1%, standard deviation = 6.9%; p < .001).

CONCLUSION

Surgical intelligence revealed a substantial percentage of OOB segments in laparoscopic gynecological procedures, alongside associations with surgeon seniority and procedure type. Further research is needed to evaluate how laparoscope removal affects postoperative outcomes and operational efficiency in surgery.

Augmenting Veterinary Minimally Invasive Surgery: Evidence-based Review of Foundational and Novel Devices and Technology

Veterinary minimally invasive surgery continues to grow as a specialty. With increasing experience in this field, comes improved accessibility as well as progressive complexity of procedures performed. Advancement in technology has been both a response to the growth and a necessary driver of continued refinement of this field. Innovative research leading to advancements in surgical equipment has led to the development of novel image acquisition platforms, cannulas, smoke evacuation systems, antifog devices, instrumentation, and ligating/hemostatic devices. These innovations will be reviewed and potential clinical applications are discussed.

A new scope warmer/cleaner for laparoscopic surgery: a disposable hot pack

BACKGROUND

Fogging and staining of a laparoscope lens negatively impact surgical visualization. We hypothesized that the disposable hot pack could not only warm but also clean laparoscopes. Hence, this study verified and developed the disposable hot pack with anti-fogging and cleaning function.

MATERIAL AND METHODS

The laparoscope was inserted into a swine abdominal cavity for five minutes. Then, the laparoscopic tip was heated with 65 °C saline or the folded disposable hot pack with nonwoven fabric coated surfactant for ten seconds (n = 15). Also, a laparoscopic tip with dirt was wiped with the prototype or conventional gauze for 10 s (n = 10). The dirt, fogging, and temperature of the laparoscopic tip were respectively evaluated after the laparoscope was inserted into the abdominal cavity.

RESULTS

The laparoscopic tip temperature five minutes after insertion into the abdominal cavity was similar (31.1 °C vs 31.2 °C, p = 0.748) and there was no fogging in both methods. The conventional gauze had significantly less temperature of the laparoscopic tip after cleaning and higher fogging occurrence than the prototype (29.5 °C vs 34.0 °C, p < 0.001, 30% vs 0%, p = 0.030, respectively), although there was no dirt left after both methods.

CONCLUSION

The disposable hot pack has a strong potential as an anti-fogging and cleaning device for use during laparoscopic surgery.

Smoke veil prior regularized surgical field desmoking without paired in-vivo data

Though deep learning-based surgical smoke removal methods have shown significant improvements in effectiveness and efficiency, the lack of paired smoke and smoke-free images in real surgical scenarios limits the performance of these methods. Therefore, methods that can achieve good generalization performance without paired in-vivo data are in high demand. In this work, we propose a smoke veil prior regularized two-stage smoke removal framework based on the physical model of smoke image formation. More precisely, in the first stage, we leverage a reconstruction loss, a consistency loss and a smoke veil prior-based regularization term to perform fully supervised training on a synthetic paired image dataset. Then a self-supervised training stage is deployed on the real smoke images, where only the consistency loss and the smoke veil prior-based loss are minimized. Experiments show that the proposed method outperforms the state-of-the-art ones on synthetic dataset. The average PSNR, SSIM and RMSE values are 21.99±2.34, 0.9001±0.0252 and 0.2151±0.0643, respectively. The qualitative visual inspection on real dataset further demonstrates the effectiveness of the proposed method.

Impaired robotic surgical visualization: archaic issues in a modern operating room

While robotic-assisted surgery (RAS) has been revolutionizing surgical procedures, it has various areas needing improvement, specifically in the visualization sector. Suboptimal vision due to lens occlusions has been a topic of concern in laparoscopic surgery but has not received much attention in robotic surgery. This study is one of the first to explore and quantify the degree of disruption encountered due to poor robotic visualization at a major academic center. In case observations across 28 RAS procedures in various specialties, any lens occlusions or "debris" events that appeared on the monitor displays and clinicians' reactions, the cause, and the location across the monitor for these events were recorded. Data were then assessed for any trends using analysis as described below. From around 44.33 h of RAS observation time, 163 debris events were recorded. 52.53% of case observation time was spent under a compromised visual field. In a subset of 15 cases, about 2.24% of the average observation time was spent cleaning the lens. Additionally, cautery was found to be the primary cause of lens occlusions and little variation was found within the spread of the debris across the monitor display. This study illustrates that in 6 (21.43%) of the cases, 90% of the observation time was spent under compromised visualization while only 2 (7.14%) of the cases had no debris or cleaning events. Additionally, we observed that cleaning the lens can be troublesome during the procedure, interrupting the operating room flow.

Laser-Enabled Surface Treatment of Disposable Endoscope Lens with Superior Antifouling and Optical Properties

Endoscopes are ubiquitous in minimally invasive or keyhole surgeries globally. However, frequent removal of endoscopes from the patient's body due to the lens contaminations results in undesirable consequences. Therefore, a cost-effective process chain to fabricate thermoplastic-based endoscope lenses with superior antifouling and optical properties is proposed in this research. Such multifunctional surface response was achieved by lubricant impregnation of nanostructures. Two types of topographies were produced by femtosecond laser processing of metallic molds, especially to produce single-tier laser-induced periodic surface structures (LIPSS) and two-tier multiscale structures (MS). Then, these two LIPSS and MS masters were used to replicate them onto two thermoplastic substrates, namely polycarbonate and cyclic olefin copolymer, by using hot embossing. Finally, the LIPSS and MS surfaces of the replicas were infiltrated by silicone oils to prepare lubricant-impregnated surfaces (LIS). Droplet sliding tests revealed that the durability of the as-prepared LIS improved with the increase of the lubricant viscosity. Moreover, the single-tier LIPSS replicas exhibited longer-lasting lubricant conservation properties than the MS ones. Also, LIPSS-LIS replicas demonstrated an excellent optical transparency, better than the MS-LIS ones, and almost match the performance of the reference polished ones. Furthermore, the LIPSS-LIS treatment led to superior antifouling characteristics, i.e., regarding fogging, blood adhesion, protein adsorption, and microalgae attachment, and thus demonstrated its high suitability for treating endoscopic lenses. Finally, a proof-of-concept LIPSS-LIS treatment of endoscope lenses was conducted that confirmed their superior multifunctional response.

Stop the Smudge: A Novel Solution to Loss of Vision During Laparoscopic Colorectal Surgery

BACKGROUND

An obscured vision of surgical field during laparoscopic surgery is inconvenient. Several temporary methods were described as solutions to loss of vision, and common practice is scope removal, cleaning, and heating. A lately developed and introduced device claims continuous clear vision during laparoscopic surgery. This study aims to present our initial experience with the device during laparoscopic colorectal surgery.

MATERIALS AND METHODS

We have included medical records of all patients scheduled for laparoscopic colorectal surgery with the device between March and August 2021 at Cleveland Clinic. Patient demographics, surgery type and time, the number of loss of vision events were recorded.

RESULTS

Fifteen patients underwent laparoscopic colorectal surgery during the study period. The median age was 42 (range: 25 to 86) years, and 10 (66%) were female. The median surgery time was 127 (range: 67 to 240) minutes, and the median loss of vision event number was 3 (1 to 6) per surgery. There was no need for laparoscope removal during any of the surgeries. All surgeries were completed without any intraoperative complications.

CONCLUSION

The novel system, provides clear vision during laparoscopic colorectal surgery with no need of scope removal for loss of vision events. The system provides removal of particulate gathering on the tip of the scope.

OUP accepted manuscript

Fogging of the thoracoscopic lens affects a surgeon’s ability to maintain a clear operating field. In uniportal video-assisted thoracoscopic surgery, the thoracoscopic lens tends to fog when the surgeon does not hold a suction instrument. Thus, a suction instrument needs to be held by the surgeon’s nondominant hand to remove surgical smoke, mist, and moisture. Here, we describe a simple, easy and cost-effective surgical smoke ventilation technique for uniportal video-assisted thoracoscopic surgery using a suction catheter to solve the problem. We present this technique and comment on its advantages, including decreased cost and improved surgical visualization.

The introduction of wide-angle 270° laparoscopy through a novel laparoscopic camera system

BACKGROUND

Laparoscopy has enjoyed improvements over the last three decades primarily in achieving high definition, but the 70° field of view (FOV) remains unchanged. Complications related to events that take place out of the FOV continue to be reported. Additional problems leading to poor visualization are fogging and smoke accumulation. A novel laparoscopic system (SurroundScope, 270Surgical) was developed and dramatically expands the FOV from the 70° to 270° by adding side cameras at the distal tip of the laparoscope, while LED illumination eliminates fogging and improves smoke effects. This study describes the initial clinical experience with SurroundScope and its potential advantages over traditional laparoscopy.

METHODS

SurroundScope was studied at Bnai Zion Medical Center in Israel and the Minnesota Institute for Minimally Invasive Surgery in America. 27 laparoscopic surgeries were performed, and at the end of each procedure, evaluations were completed by all surgeons and camera holders.

RESULTS

All 27 cases were completed successfully without adverse events. No injuries occurred as a result of surgical tool manipulation outside of the central frame while 133 potentially adverse events were identified on side frames. There was no fogging across the 27 cases. The impact of smoke was negligible in all cases, as laparoscope removal or venting was never necessary. Surgeon respondents indicated that tools could be followed from the port to the site of surgery without camera manipulation. Most surgeons strongly agreed that the potential to identify bleeding was improved. Camera holders strongly agreed that the ergonomics were improved and that they moved the camera less than with a standard laparoscope.

CONCLUSIONS

Initial results demonstrate numerous advantages for SurroundScope as compared to traditional laparoscopy. The important benefits of expanded FOV, complete lack of fogging, and negligible smoke may improve patient safety, reduce adverse events and the duration of surgery. Further investigation to quantify these benefits is recommended.

Design and Performance Testing of a Novel In Vivo Laparoscope Lens Cleaning Device

A common tool for diagnosis and treatment of gastrointestinal, gynecologic, and other anatomical pathologies is a form of minimally invasive surgery known as laparoscopy. Roughly 4 × 106 laparoscopic surgeries are performed in the U.S. every year, with an estimated 15 × 106 globally. During surgeries, lens clarity often becomes impaired via (1) condensation or (2) smearing of bodily fluids and tissues. The current gold standard solution requires scope removal from the body for cleaning, offering opportunity for decreased surgical safety and efficiency, while simultaneously generating mounting frustration for the operating room team. A novel lens cleaning device was designed and developed to clean a laparoscope lens in vivo during surgery. Benchtop experiments in a warm body simulated environment allowed quantification of lens cleaning efficacy for several lens contaminants. Image analysis techniques detected the differences between original (clean), postdebris, and postcleaning images. Mechanical testing was also executed to determine safety levels regarding potential misuse scenarios. Compared to gold standard device technologies, the novel lens cleaning device prototype showed strong performance and ability to clear a laparoscope lens of debris while mitigating the need for scope removal from the simulated surgical cavity. Mechanical testing results also suggest the design also holds inherently strong safety performance. Both objective metrics and subjective observation suggests the novel design holds promise to improve safety and efficiency during laparoscopic surgery.