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The cost effectiveness of disposable versus<a href="http://www.handlikemed.com/laparoscopic-instruments/reusable-laparoscopic-instruments/" target="_self"> reusable instruments</a> is a subject of debate. The choice of the instrument is multifactorial and depends on function, reliability and cost. So, during most laparoscopic procedures, a combination of disposable and reusable instruments is used. Frequently, disposable trocars and scissors are used, while reusable instruments can be graspers, coagulation spatula/hook and needle drivers. The commonly used laparoscopic instruments are described below.
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Uterine manipulators
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These allow uterine positioning and expand operating space. Several uterine manipulators are available – the HUMI® (Cooper Surgical), the RUMI® (Cooper Surgical), Spackman, Cohen, Hulka, Valtchev, Pelosi and Clearview® (Endopath). Some are reusable while others are disposable. Most come with a channel to perform chromotubation; however, some (such as Hulka tenaculum and Pelosi) lack this channel. With 210˚, Clearview has the greatest range of motion in the anterior-posterior plane. Hulka tenaculum, Spackman’s and Cohen’s have a straight shaft, hindering their range of motion and limiting their use in advanced<a href="http://www.handlikemed.com/laparoscopic-accessories/" target="_self"> laparoscopic accessories</a> and procedures.
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Veress needle
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This is a specially designed needle with a blunt-tipped, spring-loaded inner stylet and a sharp outer needle, used to achieve pneumoperitoneum while performing closed laparoscopy with <a href="http://www.handlikemed.com/ultrasonic-system/" target="_self">ultrasonic system</a>. It is available in disposable and reusable form, with 12cm or a 15cm length.
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Most injuries in minimally invasive surgery are associated with primary port insertion, leading to an unresolved debate on the benefits of various entry techniques (open, closed or direct entry). There is no evidence that any single technique is better in preventing major vascular or visceral complications, though there is a higher risk of failed entry with closed entry. The most recent Cochrane review concluded there is a lower risk of vascular injury with the direct entry in comparison to use of Veress needle.3
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Trocars/cannulas
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These are used to create small passageways through the abdominal wall and are available in different textures (see Figure 1). Disposable and reusable trocars in various sizes are available and share the following common parts:
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Sharp tips cut an entry path through the abdominal wall while blunt tips stretch the tissues apart to gain access to the peritoneal cavity.
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Sleeve: is the working channel. Trocar sleeves or collars can have textures on the outer surface of the trocar that help it anchor to the abdominal wall. Some have an internal inflatable balloon at their tip and plastic/rubber ring to provide anchorage.
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Valve: different valve systems prevent gas leaking from trocars and allow the insertion of instruments.
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Side port: many trocars come with a side port that allows for gas insufflation or smoke evacuation.
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Laparoscopes
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The telescopes used in laparoscopy are available in sizes ranging from 2mm up to 12mm. The 10mm size is the one most commonly used in gynaecology. Similar to a hysteroscope, a laparoscope can come with an angle of view such as 0˚, 30˚ or 45˚. In an angled-view scope, the direction of vision points away from light source attachment. The 0˚ telescope offers a forward view corresponding to the natural approach and is preferred by most gynaecologists. It is useful if a less-experienced assistant is available. The 30˚ telescope can be rotated to enlarge field of view and can be advantageous for complicated cases. The 45˚ telescope is useful in single-incision laparoscopies, but is not commonly available. Every laparoscope has an engraved number by the eyepiece that specifies the viewing angle.
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