The growing field and practice of minimally invasive laparoscopic surgery relies heavily on the use of medical instruments equipped with video and imaging technology. The quality of the image affects the efficiency, quality and safety of the surgery. As a result, it is imperative to ensure the laparoscope or endoscope lens remains free of condensation, debris, dirt, smoke and bodily fluids or other particles that may impair vision.

Unfortunately, maintaining visual clarity during surgery has long been a critical, unsolved problem in minimally invasive surgery. Condensation buildup is very common during the first part of surgery and throughout the surgical case, as particulate debris (smoke, fat, morselized tissue) continuously settles on the lens of the scope obscuring the surgeon’s vision. Both of these scenarios create frequent interruptions during surgery for scope removal, manual cleaning and re-insertion. This commonly-accepted practice results in decreased operational efficiency, interrupted surgical focus and possible patient risk.

This common scenario can be found across the world. Various design solutions including heating the lens prior to insertion and/or washing/cleaning the lens ex-situ have proved to be inconsistent and require constant removal of the scope throughout the surgical case. New technology, however, provides a consistent, clear image during surgery while virtually eliminating the need to remove the scope from the patient’s body.

Dual-Purpose Design
During laparoscopic surgery, CO2 gas is used to inflate the abdominal cavity to create a space for surgery. New technology diverts a portion of the CO2 gas and through a sheath enabled system (which fits smoothly over the laparoscope), creating a constant vortex barrier of CO2 gas over the end of the lens. This design effectively keeps the lens clear of condensation and fog while also shielding the lens from smoke and particulate debris. It’s a novel approach that required a unique design solution to ensure the flow of CO2 gas created a barrier as opposed to a vacuum. The instrument is designed to selectively steer different amounts of CO2 gas flowing at different velocities down the four conduits built into the device to turn the CO2 gas into a spinning vortex barrier that defogs the lens and pushes debris away from the lens.

Bio-Friendly Composition
While this design concept virtually eliminates the need to remove the scope from the patient’s body, no design is entirely successful unless it can completely solve a problem. For example, from time to time, bodily debris may penetrate the vortex barrier (a matter of terminal velocity or mass) or a surgeon may touch the lens to tissue causing a greasy smudge on the lens. With this eventuality in mind, the device engineer developed the first intraoperative, biocompatible flushing surfactant approved by the Federal Drug Administration. The surfactant is used in situ to dissolve fat and wash away any remaining debris on the lens, allowing the lens to be cleaned without removing it from the patient.

Design Application for the Future
While most medical device designs are based off an existing applied engineering principle, this is an entirely new concept within the medical field. It offers potential applications across other medical specialties. The new technology could be applied to any lens, allowing modern video systems to perform to their potential instead of being hindered by naturally occurring debris. Eliminating visual impairment and lens removal during medical procedures with optics can elevate the standard of care for minimally invasive surgery.

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