Care and maintenance of a laparoscopic instrument is an important and necessary task for every surgical department. This article provides you with a step by step approach to the task of maintenance, care and preparation of a laparoscopic instrumentation system.
Washing of instruments
It should be remembered that washing, i.e. cleaning, is the most important thing in the maintenance of a laparoscopic instrument. The objective of washing is to reduce the number of microorganisms on the instruments.
Once the instruments have been used, at the end of the surgery, they should be immediately transferred to the washing area, for which a container with an adequate lid should be available; sharp (scissors, needles, trocars, and punches) should be handled with care; the jaws of the instruments should be opened, with or without a zipper; and the assemblable instruments, such as forceps and scissors, should be disassembled.
For washing, an enzymatic detergent should be used, which has the properties of dissolving and digesting blood, mucous remains, fecal material, proteins and any other organic matter, in addition to removing dirt. It is very important that this enzymatic detergent is prepared with distilled water, because if the instruments are in contact with saline solutions they will be exposed to oxidation, due to their high corrosive power.
The instruments should be organized according to consistency, weight and fragility and should be thoroughly checked to determine the degree of cleanliness and detect blunt, rusty instruments or loss of functional capacity, deterioration of joints and zippers, poor cutting etc., which will disqualify them for use in surgery. After washing, the instruments should be rinsed with distilled water, removing organic matter from the jaws of forceps, trocars and punches that were used until the end of surgery.
Instruments Used in Laparoscopy
Forceps are detachable and consist of handles, sheaths and inserts.
They are different types of laparoscopic scissors: hook scissors, straight and curved Metzenbaum scissors, curved and straight micro scissors.
Laparoscopic forceps can be dissecting and grasping forceps (which are traumatic or atraumatic) dissecting forceps; among the dissecting and grasping forceps are the Reddick-Olsen forceps or click-line forceps.
There are also trocars, which consist of the trocar cannula plus a trocar with a conical tip and a trocar with a pyramidal tip.
The Veress needle is a small needle, which is used to make punctures.
Finally there are the optics, which are of different degrees (there are 0,30 and 45 degrees).
Preparation of Instruments
The preparation of instruments is done by sets; for example, there are laparoscopic surgery boxes for cholecystectomy, hernia surgery or gynecology; this availability by set allows the material to be available promptly and quickly.
It is important to record in a book the incidents that occur with these instruments during the operation, as well as the type of operation and the surgeon responsible, which will allow control of the useful life of the instruments, which is related to the complexity and number of operations and to the quality of the product. An orderly record makes it possible to detect and identify a surgical team that breaks the protocols of handling and conservation of the material, depending on a specific surgery.
