Effective cleaning of endoscopic lenses to achieve visual clarity for minimally invasive abdominopelvic surgery: a systematic review

Ahmad Nabeel1,2,3 · Salman K. Al‐Sabah3,4 · Hutan Ashrafan1,2

Received: 11 October 2020 / Accepted: 17 April 2021 © The Author(s) 2021

Abstract

Objective: To review the recently available interventions to achieve optimal visual clarity in laparoscopic abdominopelvic surgery compared to conventional cleaning alternatives. Summary background data Currently, there is no consensus on the most effective method for the cleaning of endoscopic lenses used in minimally invasive abdominopelvic surgery.

Methods: Literature searching for articles relevant to answering a predefined research question was performed in December 2019 and involved searching of the electronic databases of MEDLINE, the Cochrane Registry, and EMBASE. Basic search terms were derived using the PICO (population, intervention, comparator, and outcomes) framework and through a scoping search of literature via MEDLINE. A manual search of Google Scholar and citation screening of eligible studies was also performed to ensure the identification and inclusion of all pertinent studies to address the research question.

Results: Among conventional and readily available methods, the most effective approaches involved heated sterile water, heating of laparoscope lenses, and surfactant solutions, including FRED and Ultra-Stop, while evaluations of all novel devices and methods were more effective than controls, which included lens wiping systems and air and carbon dioxide flow systems. While the former surgical techniques were consistently associated with superior lens cleaning ability and/or defogging capability and subsequent optical clarity of images within the surgical field, no methods conferred any meaningful effects upon other clinically important outcomes, such as operative time, costs, complication rates and length of stay, suggesting that decision-making concerning the selection of lens cleaning method/device should suit the preferences of the instrument operator and/or the responsible surgeon.

Conclusions: We demonstrated that a range of endoscopic lens cleaning methods and devices could be used to achieve sufficient optical clarity of the laparoscopic surgical field by either preventing lenses from fogging and/or facilitating the inter-operative cleaning of fouled lenses. Despite the various methods evaluated in this review, there were no significant
differences in complication rates between the intervention and control groups.

View full abstract here: Effective cleaning of endoscopic lenses to achieve visual clarity for minimally invasive abdominopelvic surgery: a systematic review

Introduction to Laparoscopic Surgical Procedures

This document is designed to provide the reader with a base level understanding on a range of laparoscopic procedures and how OpClear^® can help the clinical team whilst performing them.

It is divided in to key speciality sub groups of;

• Upper Gastro intestinal and Bariatrics
• Hepato-Biliary and Pancreatic
• Colo-Rectal
• Urology and Kidney Transplant
• Gynaecology
• Endocrinology
• Procedures that bridge specialities

Further reading can be obtained from the Internet and or text books but there is no substitution to asking a surgical team to observe a procedure as an educational learning experience. In doing so, and whilst observing a procedure, identifying the associated benefits of OpClear^® to and for the individual surgeon will make for a personal sell.

This document is work in progress. As we each build our personal experience feel free to add or comment to this educational material.

View the full PDF document here: Cipher Surgical Procedures July 2020

The Efficacy and User Operability of an Intrabdominal Optical Lens Cleaning Device During Laparoscopic Excisional Surgery for Deeply Infiltrating Endometriosis: a Video Presentation

Ahmed J, Hulme E, Bansal J, Bidmead J 

King’s College Endometriosis Centre, King’s College Hospital, London UK 

Background 

During laparoscopic excisional surgery for deeply infiltrating endometriosis, the need for a near–field view of the operative site deep within the endopelvic fossae poses challenges. Bleeding, condensation, smears from neighbouring fatty structures and plume spatter from ultrasonic dissection necessitates removal and reinsertion of the laparoscope for lens cleaning, prolonging surgical time and requiring reorientation of the surgical view. 

Methods 

In this video presentation, we demonstrate our in–service pilot study of a proprietary device (OpClear, Cipher Surgical, Coventry UK) to determine its user operability. The device comprises a thin sheath placed over the laparoscope delivering a fluid supply to the optical tip, automatically defogging the lens during use and permitting surgeon–activated cleaning without laparoscope removal from the abdomen. 

These video cases demonstrate how intrabdominal lens cleaning permits the operating surgeon to maintain the laparoscope in position during crucial points of the deep pelvic dissection facilitating uninterrupted excision. 

Conclusions 

The use of an intrabdominal lens cleaning device permits laparoscopic excisional surgery for deep endometriosis without repeated removal, cleaning and reinsertion. 

The efficacy and user operability of a intrabdominal optical lens cleaning device during laparoscopic excisional surgery for deeply infiltrating endometriosis

ABSTRACT

Background and Objectives: Laparoscopic surgery can be complicated by condensation and debris on the lens obscuring the visual field, increasing the risk of surgical error and injury to the patient. Despite, development of possible solutions, little is known regarding the quantitative measure of time lost during surgery because of an obscured visual field. Without this knowledge, the cost of laparoscopic lens fogging cannot be quantified and compared to the cost of antifogging devices.

In the present study, we investigated the amount of time a laparoscope is withdrawn for cleaning during surgery.

View the full abstract here: Quantifying Intraoperative Laparoscopic Visual Field Opacity – JSLS