The laparoscopic cart components are:
• a carbon dioxide source and insufflator
• video monitors
• recording media.
Carbon dioxide source and insufflator. Carbon dioxide is stored in containers at a pressure of about 50 bar, so the containers must be carefully secured to the cart to prevent accidents in the OR. They are connected to an insufflator, which can generate and control the flow of CO2 into the abdominal cavity, assuring a maximal flow of 30 l/min. The machine has automatic pressure and flow regulators that adjust the flow of CO2 to maintain a stable intra-abdominal pressure of 12-14 mmHg. Acoustic and visual alarms can be preset and alert the surgeon in the event of any change in abdominal pressure. Flow per minute, abdominal pressure, gas volume used and insufflation pressure are constantly indicated on the machine.
Light source. The light source is normally a 300-W xenon lamp producing a light very similar to sunlight allowing for automatic or manual light intensity regulation. It has a stand-by position that allows the power of the light to be reduced when it is not needed without turning the lamp off, thereby prolonging lamp life.
Camera system. The camera system is connected to the camera and the 30° laparoscope. It has a video input and three outputs with different resolutions. The red, green and blue (RGB) output is the one with the best resolution power and must be connected to the primary video monitor. Colour must be calibrated by white balancing before starting each procedure. The remaining outputs can be used for a satellite monitor and the recording system.
Video monitors. A high-resolution video monitor is connected to the camera system. It is preferable to connect it using 2 outputs from the camera system (RGG and Y/C) so as to be able to change channel in the event of one of the connections failing. One input to the video should be connected to a video recorder to enable a check on what the video recorder is recording at any given time.
Recording media. Several types of video recorder are available (digital or analogue), so images can be stored in analogue VHS, U-matic or Betacam recorders. It is preferable to use optical recordings that allow for the storage of images in optical disks (DVD, CD).
Traditional laparoscopy significantly differs from open surgery and new, unnatural technical skills have to be learned to perform major operations such as col-orectal resections proficiently. In laparoscopy, there is a loss of manual dexterity because: (1) the instruments are straight and have a fulcrum at the port entry, so movements are reversed; (2) straight instruments completely lack the complex articulation characterising a human hand; (3) there is no three-dimensional view as in direct binocular human vision.
A new generation of advanced robotic systems has recently been designed to overcome these drawbacks, however. The da Vinci robotic surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA) offers a three-dimensional view, and it exactly translates the surgeon's hand movements to the tips of the surgical instruments, which have a wrist-like articulation. In addition, it holds the camera in a stable position that can be adjusted directly by the surgeon to optimise the view of the surgical field.
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