Improving vision during laparoscopic surgery

Safe and effective surgery is dependent upon good vision. In conventional open surgery, good vision is achieved through the surgeon’s direct view of the operative field. In turn, this is dependent on the access provided by an appropriately positioned and sized wound, usually with additional wound retraction and well-directed theatre lighting. However, in laparoscopic surgery, where wounds are reduced to a minimum, direct vision is exchanged for images on a monitor derived from a camera system viewing internal structures via the laparoscope. In such surgery, surgeons are then dependent not only on their eyes but also the clarity of image produced by this complex system. 

Those unfamiliar with laparoscopic surgery would expect, somewhat intuitively, that the vision provided to the surgeon during laparoscopic procedures would be of a constant, high-level of acuity. However, laparoscopic surgeons recognise this is not the case. Indeed, it is a universal experience for laparoscopic surgeons that intraoperative vision may be critically impaired by material gathering on the distal laparoscopic lens. 

Such material has three principal origins. Firstly, condensation accumulates on the lens due to the humidity of the intraperitoneal environment. Condensation can occur throughout the procedure but is almost inevitable at the beginning of a case when the relatively cold laparoscope is first inserted into the abdominal cavity. On the monitor, image condensation is seen as a fogging effect varying in density from slight misting to complete obstruction of view.