Читать книгу Small Animal Laparoscopy and Thoracoscopy онлайн
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Instruments for minimally invasive surgery (MIS) consist of the same basic parts as traditional instruments (ssss1). Their shafts are long and thin to allow them to pass through an instrument portal into a body cavity. Some shafts are insulated to allow for monopolar or bipolar electrosurgical applications. If using an insulated shaft with electrosurgery, it is very important to regularly inspect the shafts for cracks or wear. Defects in the shaft insulation may lead to inadvertent electrical burns to other tissues. Shafts come in straight, articulating, and roticulating designs. Articulating shafts bend in a single plane, whereas roticulating shafts are able to rotate and bend in multiple planes, more accurately mimicking the motion of the human wrist. The choice of shaft configuration used depends on the intended approach, the procedure to be performed, and the surgeon's level of experience and preference. Straight instruments are the basic instruments for MIS and are most commonly used by novice surgeons and in multiple‐port surgery. While they can be used in single‐port approaches, difficulty in attaining optimal instrument positioning and instrument clashing are common problems encountered when using straight instruments through a single port. Articulating and, later, roticulating shafts were developed to allow for better tissue visualization, more accurate instrument angles in relation to the target tissues, and less conflict between instruments and the telescope when used in single‐port procedures. Both articulating and roticulating shafts are also beneficial in advanced, multiple port procedures, such as cholecystectomy, where the articulating/roticulating dissectors allow for a more correct angle to dissect around the cystic duct. Articulating and roticulating shafts are available for a variety of instruments including dissectors, graspers, scissors, and staplers. A steep learning curve has been reported for performing single‐port procedures using articulating or roticulating instruments. When starting to use these instruments, it is recommended to become comfortable using the articulating shafts before progressing to operating with the roticulating shafts. Recently, some manufacturers have discontinued articulating shafts and solely offer roticulating instruments.