World Laparoscopy Hospital Gurugram, Haryana

The dimensions shape, and material from the ureteral stent for use depends upon the patient's anatomy and also the reason that stent is needed. Most stents are 5-12 inches (12-30 cm) long, and also have a diameter of 0.06-0.2 inches 1.5-6 mm. Either ends from the stent might be coiled (known as a pigtail stent) to avoid it motionless unnatural; an open-ended stent is much better suited to patients who need short-lived drainage. Sometimes, one end from the stent includes a thread mounted on it that extends with the bladder and urethra towards the outside the body; this helps with stent elimination. The stent material should be bendable, durable, non-reactive, and radiopaque visible with an x-ray.

The Electronic CO2 Laproflattor is a general purpose insufflation unit for use in laparoscopic examinations and operations. Controlled pressure insufflation of the peritoneal cavity is used to achieve the necessary work space for laparoscopic surgery by distending the antero-lateral abdominal wall and depressing the hollow organs and soft tissues. Carbon dioxide is the preferred gas because it does not support combustion, it is very soluble which reduces the risk of gas embolism, and is cheap. Automatic insufflators allow the surgeon to preset the insufflating pressure, and the device supplies gas until the required intra-abdominal pressure is reached. The insufflator activates and delivers gas automatically when the intra-abdominal pressure falls because of gas escape or leakage from the ports. The required values for pressure and flow can be set exactly using jog keys and digital displays. Insufflation pressure can be continuously varied from 0 to 30 mm Hg; total gas flow volumes can be set to any value in the range 0-9.9 litersmm.

Jean-Claude Margueron of Emar in Fourteenth Century BC invented Scissors [1]. Scissors are one of the oldest surgical instruments used by surgeons. Scissors are used to perform many tasks in open surgical procedure but its use in minimal access surgery is restricted. In minimal access surgery scissors require greater skill because in inexperienced hand it may cause unnecessary bleeding and damage to important structures.

Laparoscopic surgery requires sophisticated and precisely calibrated instruments. The essential difference between instruments used in open surgery and people utilized for laparoscopic surgery would be that the latter are more complex in design and yet delicate in construction. Thus the laparoscopic instruments are more vulnerable to lodging of bioburden (micro-organisms and debris) within their crevices. Thus, the LI are difficult to clean, sterilize adequately and maintain as compared to their counterparts used in open surgery. Moreover, owing to their delicate design, gentlest methods have to be used for cleaning in addition to sterilization. Also, meticulous cleaning, maintenance in addition to sterilization are necessary so that not to compromise the safety from the patient, the surgeon or other operating room personnel. The rise in complexity of the laparoscopic procedures as also the emergence of resistant strains of bacteria, mycobacteria, fungi and viruses makes it imperative to effectively clean and disinfect instruments. Sterilization is the absolute elimination or destruction of forms of microbial life. It may be achieved with steam, gas or chemicals. However, disinfection is the relative removal of pathogenic organisms except spores.

Light is essential for performing most of the modus operandi of life. Thanks to Edison who discovered electric bulb. The Minimal access surgery depends on the artificial light available in closed body cavity, and before the discovery of light source and light cable; mirrors were used to reflect the light onto the subject where the direct light access was not possible. In 1867 Bruck, a Dentist from Breslau, made a platinum wire loop which he heated with electric current, and used that as a light source for purpose of surgery. Endoscopy was performed, by using tungsten light bulbs inside the body cavity before 1954. These bulbs were emitting low frequency red color of light. The bulb was so hot that there was always a risk of injury to bowel.

Many senior surgeon started saying "Laparoscopy is conspiracy against common man". Minimal access surgery has developed rapidly only after grand success of laparoscopic cholecystectomy. Recently computerized designing of laparoscopic instrument is introduced and microprocessor controlled safety features are added. Now it is impossible to stop the speed of growth of minimal access surgery and every day new procedures are added on its list. Laparoscopy is a technologically dependent surgery and before starting surgery every surgeon should have reasonably good knowledge of these instruments.