This two-part presentation outlines the principles and methods of functioning of the main medico-technical devices required to perform laparoscopic surgery.
The first part deals with the laparoscopic unit components including the insufflator, light sources, the evolution of cameras and screens, as well as scopes used in laparoscopic surgery. For each component, operating principles, technological developments, malfunctions and their management are discussed.
The second part presents operating modalities based on novel innovative energy technologies which are used to control tissues. Their operating modalities, specific risks and prevention means are envisaged. This relates in the first place to the evolution of the use of high frequency currents delivering monopolar and bipolar currents within tissues. New ways of management of these currents with tissue vessel-sealing processes are also discussed. Finally, the principles, use and risks of the new means of dissection and tissue sealing with ultrasonic devices are addressed.
The operating principles and the specific risks of all these systems are not well known to surgeons. In case they are not correctly used, they represent new risks and surgeons should be aware of it.
In conclusion, ergonomic choices of conventional instrumentation in minimally invasive surgery are outlined.

Not only does surgical tissue dissection require control of main vessels but it also mandates hemostasis of capillaries located in dissection areas. Surgeons can use mechanical means of tissue control, clips, staples, and sutures. They can also use physical means including radiofrequency-induced tissue fusion (electrocautery to achieve division and coagulation) and ultrasound.

The principles of these systems rely on an increased temperature of tissues through a molecular agitation or mechanical means conducive to the dessication of tissues, the fusion of proteins, and to a series of coagulations and divisions.

The use of such effective systems can be associated with specific complications. Consequently, it is mandatory for surgeons to know the principles and risks related to their use. Indeed, surgeons will be the end-users of such devices and of their effects.
They must be able to inform their patients and prevent the occurrence of accidents which may result in intraoperative or postoperative complications for which they can be directly blamed.

In this presentation, the principles of tissue control systems, their potential risks, as well as the prevention of any related accidents are outlined. Electrosurgery and ultrasound use will be respectively addressed along with indications and specific risks associated with their use.

Techniques and principles of the new applications of electrocautery controlled by electronic systems (e.g., LigaSure™ vessel-sealing device, Covidien-Valleylab, ultrasound fusion devices such as Sonicision™, Covidien-Valleylab) are described, as well as their benefits and limitations. The specificities and privileged indications for the use of such systems will be detailed. Finally, standard instruments indispensable for laparoscopic interventions will be addressed.

The performance of surgical procedures using laparoscopy changes the surgeon’s vision of the operative field. The surgeon works with direct vision using a monitor, hence visualizing the operative field in optimal conditions. The surgeon’s working space is limited to the abdominal cavity, and the surgeon no longer has to focus on the entire operating theater.

This implies that an original operative area made up of the abdominal cavity, for digestive surgeons, must be created. The creation of this working space is achieved by means of controlled carbon dioxide insufflation into the abdominal cavity.

The operative image will be conveyed once the operative field has been lit up using a white light source (named cold light as it provides a 6000K color corresponding to sunlight color). The image is first captured by a camera which transforms colors into digital data through Charge-Coupled Device (CCD) captors. It will then be transmitted through a digital screen. This method of image creation depends on the quality and technique of each part of this chain. The quality of surgical video images has evolved rapidly over the years as there have been tremendous advances in computer science and video technologies. In 2014, the current standard is the HD camera, which conveys an accurate image through a HD monitor. Scopes have been steadily improving, image quality has been enhanced, especially when it comes to brightness and definition. Tomorrow, the image will be stereoscopic and 4K, hence pushing the standards of image-guided surgery forward.

All the components of this "image sequence" will be taken into consideration in order to offer surgeons not only the possibility to have basic knowledge of instrumentation to maximize their choice of brand-new armamentarium but also to understand the technical malfunctions likely to alter surgical image quality so as to make up for such shortcomings.

This key lecture authored by Professor Didier Mutter was given during the last advanced course in operative gynecological endoscopy at the IRCAD Strasbourg last May 14-16, 2012.
Professor Mutter, MD, PhD, FACS, describes the new energy devices, which can be used in laparoscopic surgery. A good knowledge of energy is essential for security reasons as well as for an adequate use of the different devices available. Clinical applications are combined with theoretical notions to promote a good understanding of all energy devices.

What are the different electrosurgical modalities for achieving hemostasis? How do they work?
What are the principles of selection and safe use of these modalities?
These issues are beautifully discussed by Prof. Mutter in this state-of-the-art lecture.

In this lecture, Prof. Leroy takes us through the different types of trocars, as well as the basic principles of port positioning. He also discusses the pros and cons of different techniques for accessing the abdominal cavity.

Understanding the basics of laparoscopic instrumentation (be they insufflators, cameras, light source, scopes, etc.) is essential to a successful laparoscopic surgeon.
This topic is nicely reviewed by Prof. Mutter in this 30-minute lecture.

The description of the Endoscopes covers all aspects of the surgical procedure used for the management of (description de la pathologie en cause).
Operating room set up, position of patient and equipment, instruments used are thoroughly described. The technical key steps of the surgical procedure are presented in a step by step way: Introduction, Structure/function, Choice of endoscopes, Advantages/disadvantages, Practical issues, Usage problems, Conclusions.
Consequently, this operating technique is well standardized for the management of this condition.

The description of 3D vision covers all aspects of 3D vision relating to the operating room.
The technical key steps of the chapter are presented in a step by step way: historical overview, physiology of 3D vision, visual conditions, available material, advantages/disadvantages.

The description of the insufflator in laparoscopy covers all aspects of this piece of equipment.
The technical key steps of the chapter are presented in a step by step way: background, operating principles, prerequisite for laparoscopy, available features, advantages and disadvantages, use and settings, pathophysiological effects, surgical complications, alternatives, criteria for purchase.

The description of laparoscopic instruments covers all aspects of laparoscopic instruments in the operating room.
The technical key steps of the chapter are presented in a step by step way: structure/function, ideal requirements, basic instruments, trocars, advantages and disadvantages, ergonomics, suction-irrigation, clips and staples, complications.

The description of ergonomics covers all aspects of ergonomics in the operating room.
The technical key steps of the chapter are presented in a step by step way: specificities of laparoscopy, ergonomics, ideal trocar positioning, basic movements/gestures, knot-tying, complications.

The description of access and trocar complications covers all access techniques and the nature, prevention and treatment of injuries associated with minimally invasive peritoneal access.
The technical key steps of the chapter are presented in a step by step way: trocars, hand-assisted laparoscopic surgery (HALS), fixation systems, direct vision, blind techniques, remaining trocars, injuries, closure, hernias.

The description of the video camera covers all aspects of this piece of equipment. The technical key steps of the chapter are presented in a step by step way: structure/function, laparoscopic requirements, choices of camera system, advantages/disadvantages, practical issues, usage problems.
Consequently, this operating technique is well standardized for the management of this condition.

The description of the video monitor covers all aspects of the video monitor in the operating room.
The technical key steps of the surgical procedure are presented in a step by step way: monitors, principles of function, ideal requirements/laparoscopy, available material, usage and adjustments, usage problems.

The description of the cold light source covers all aspects of this piece of equipment.
The technical key steps of the chapter are presented in a step by step way: principles of function, ideal requirements for laparoscopy, available material, advantages/disadvantages, usage and adjustments, usage problems, criteria of choice.

The description of ultrasonic dissectors (UDs) covers all aspects of such instruments.
The key steps of the description are presented in a step by step way: utrasound cavitation, ultrasonic dissectors, advantages of UDs, drawbacks of UDs, indications, features of scissors.

The description of electrocautery and high-frequency currents in surgery covers all basic principles.
The key steps of the chapter are presented in a step by step way: use of electric currents, generation of use, tissue effect, types of cauterization, surgical equipment, complications of bipolar cautery, complications of monopolar cautery, Argon plasma coagulation, new electrosurgical techniques, lasers, ultrasonic dissectors.