Laparoscopic lens fogging: solving a common surgical problem in standard and robotic laparoscopes via a scientific model
Laparoscopic lens fogging (LLF) hampers vision and impedes operative efficiency. Attempts to reduce LLF have led to the development of various anti-fogging fluids and warming devices. Limited literature exists directly comparing these techniques. We constructed a model peritoneum to simulate LLF and to compare the efficacy of various anti-fogging techniques.
Materials and methods
Intraperitoneal space was simulated using a suction bag suspended within an 8 L container of water. LLF was induced by varying the temperature and humidity within the model peritoneum. Various anti-fogging techniques were assessed including scope warmers, FREDTM, ResoclearTM, chlorhexidine, betadine and immersion in heated saline. These products were trialled with and without the use of a disposable scope warmer. Vision scores were evaluated by the same investigator for all tests and rated according to a predetermined scale. Fogging was assessed for each product or technique 30 times and a mean vision rating was recorded.
All products tested imparted some benefit, but FREDTM performed better than all other techniques. Betadine and ResoclearTM performed no better than the use of a scope warmer alone. Immersion in saline prior to insertion resulted in decreased vision ratings. The robotic scope did not result in LLF within the model.
In standard laparoscopes, the most superior preventative measure was FREDTM utilised on a pre-warmed scope. Despite improvements in LLF with other products FREDTM was better than all other techniques. The robotic laparoscope performed superiorly regarding LLF compared to standard laparoscope.
KeywordsSurgery Laparoscopic surgery Fogging Laparoscopic lens fogging Robotic surgery Laparoscopic equipment
No funding was received to conduct this research. The manuscript has been seen and approved by all authors.
Compliance with ethical standards
The authors Dr. Todd G Manning, Dr. Nathan Papa, Dr. Marlon Perera, Dr. Shannon McGrath, Dr. Daniel Christidis, Dr. Munad Khan, Mr. Richard O’Beirne, Dr. Nicholas Campbell, Prof. Damien Bolton and A/Prof. Nathan Lawrentschuk have no conflicts of interest or financial ties to disclose.
- 1.Dubois F, Icard P, Berthelot G, Levard H (1990) Coelioscopic cholecystectomy: preliminary report of 36 cases. Lippincott Williams & Wilkins, WK Health, PhiladelphiaGoogle Scholar
- 6.Manning TG, Perera M, Christidis D, Kinnear N, McGrath S, O’Beirne R, Zotov P, Bolton D, Lawrentschuk N (2017) Visual occlusion during minimally invasive surgery: a contemporary review of methods to reduce laparoscopic and robotic lens fogging and other sources of optical loss. J Endourol. 31(4):327–333CrossRefPubMedGoogle Scholar
- 18.North GR, Erukhimova TL (2009) Atmospheric thermodynamics. [electronic resource]: elementary physics and chemistry. Cambridge University Press, CambridgeGoogle Scholar
- 24.Sarah P, Conley SS, Benjamin R (2016) lee urologic robotic surgery course. American Urolological Association. https://www.auanet.org/education/modules/robotic-surgery/module1.cfm. Accessed 01 May 2016
- 25.Wong CG, Gu X, Barkoukis M (2013) Novel laparoscope defogging and cleaning device for robot-assisted laparoscopic prostatectomy (RALP). J Endourol 27(1):144Google Scholar
- 27.Nezhat C, Morozov V (2008) A simple solution to lens fogging during robotic and laparoscopic surgery. J Soc Laparoendosc Surg 12(4):431Google Scholar
- 28.Khan MJ, Karim O (2013) Use of Ethicon Vicryl foil and robotic camera lights to warm the robotic scope lens to prevent lens fogging, 2nd edn. Wiley, HobokenGoogle Scholar
- 30.Piromchai P, Kasemsiri P, Thanaviratananich S (2011) Alternative agents to prevent fogging in head and neck endoscopy. Clin Med Insights 4:1Google Scholar