Excellent visualization and exposure of the surgical field is vitally important during laparoscopic procedures. "The clearer the picture, the sharper the image, the better the idea you have of what needs to be done," says general surgeon Mark Engels-gjerd, MD, of St. Cloud, Minn. "That might seem like it goes without saying, but not every facility steps up to get the best available technology." What about you? Have you recently invested in safer surgery and better case outcomes?

Upgrade to HD
Five ORs at Pinnacle Health's Harrisburg, Pa., campus have been upgraded for cutting-edge minimally invasive surgery, says Susan Comp, MS, BSN, CNOR, the health system's vice president of surgical services. The rooms cost about $2.5 million to overhaul, an investment that Ms. Comp says was worth every penny considering the returns she's received in improved surgeon satisfaction and faster case times.

Each OR is filled with high-def flat screens, giving surgeons and staff crisp, clear images of surgery seemingly wherever they look. "The visualization is so much better for surgeons, who see more of the abdominal cavity with HD's wide-angle images," says Ms. Comp, adding that surgeons who see better operate faster and safer. Lap choles that used to take her surgeons 45 minutes to complete can now be done in about a half-hour.

Karen Kinsley, MSN, RN, CNOR, was sure to install high-def technology in CentraCare Surgery Center's ORs when the facility was built 5 years ago. She was fortunate to have a health system's deep pockets backing the investment and concedes smaller facilities may not have the budget to pull the trigger on an imaging upgrade, but is quick to point out how much the technology pays off on the back end. "It's definitely an advantage when you're trying to attract physicians," says CentraCare's director of surgery.

Dr. Engelsgjerd can attest to the benefits of bringing his cases to Ms. Kinsley's center so he can operate in HD. "Clear views of the structure you're working on and around can limit complications and result in safer surgery," he says. For example, Dr. Engelsgjerd points out that performing lap choles in HD lets surgeons better identify the common bile duct and avoid nicking the delicate structure, which limits the risks of a potentially life-threatening complication.

Improve the instruments
Blue Mountain Health System, located in central Pennsylvania, recently outfitted the ORs at its Palmerton and Gnaden Huetten campuses with state-of-the-art laparoscopic imaging systems and instrumentation. The new instruments are durable, ergonomically designed, limit reflection of the laparoscope's light and offer physicians improved retracting and grasping, says Trish Green, RN, BSN, Blue Mountain's director of surgical services. She believes the new and improved instrumentation lets surgeons maneuver safer and faster in the surgical cavity, which shaves about 10 or 15 minutes off of the typical case time. "That means patients spend less time under anesthesia," she says. "It may be a matter of minutes, but even 5 fewer minutes of anesthesia time is better for patients."

Most of Ms. Comp's laparoscopic surgeons are using newer 5mm ports and scopes instead of older 10mm versions. The upgraded scopes "provide excellent visualization" while also requiring smaller incisions in the patient's abdominal wall, she says. Her surgeons used to use snake and fan retractors, but says newer retractors are refined and easier to manipulate, letting surgeons move tissue around with ease in order to gain better views of and access to the organs they're targeting.

Sabrina Ross, MD, an assistant professor in the department of surgery at the University of South Florida in Tampa, specializes in a wide range of minimally invasive procedures, including single-incision surgery, an approach that heightens the need for articulating instrumentation that improves the freedom of movement within the abdominal cavity. Dr. Ross uses a 5mm laparoscope with a deflectable tip, which she controls with her left hand and places on the anterior wall of the abdomen. She positions a dissecting instrument or cautery device within the abdominal cavity using her right hand. Since the tip of the laparoscope moves while its shaft remains stationary, Dr. Ross is able to maximize the instruments' range of movement and the all-important triangulation without compromising her view of the surgical field.

Clear the fog
Fogging of the laparoscope's lens is an annoying issue for surgeons that hampers their visualization of the surgical field and slows down case times. Ms. Comp's surgical team is thrilled with her hospital's new scope warmer. "With just a twist, it begins to heat up in 30 seconds and stays warm for up to 2 1/2 hours," she says. "This has been a significant upgrade because the surgeon no longer has to remove the scope to defog it."

The drawbacks of having to repeatedly remove the laparoscope for cleaning extend beyond mere annoyance. "You lose complete sight of the surgical cavity for the 30 seconds it takes to clean the lens," says Ms. Green. Technologies that keep lenses clear and fog-free throughout a case maintain constant visualization of the abdomen's delicate organs. "That's a great thing for patient safety."

It's also a great thing for maintaining case efficiencies, says Dr. Ross: "To limit time wasted establishing and re-establishing instruments within the abdominal cavity in the same position and exposure, surgeons need to limit the number of times they pass the laparoscope across the access port."

Something for everyone
Ms. Comp speaks for many efficiency-minded administrators when summing up the importance of improving her surgeons' views of the abdominal cavity: "You see it. You do it. You get out of there." For surgeons, improved visualization is about performing better surgery. "The more details you see, the more confident you are about what you're looking at," says Dr. Ross. Whichever way you look at it, enhancing what your surgeons see during laparoscopic cases is a win-win.