Minimally Invasive Surgery: Equipment and Troubleshooting

The field of minimally invasive surgery has evolved rapidly since the first laparoscopic appendectomies and cholecystectomies were performed nearly 30 years ago.1 Minimally invasive approaches are now widely used for gastrointestinal resection, hernia repair, antireflux surgery, bariatric surgery, and solid-organ surgery, such as hepatic, pancreatic, adrenal, and renal resections. Although the techniques and equipment needed to access, expose, and dissect vary according to the type of operation and surgeon’s preference, a basic set of equipment is essential for any laparoscopic or robotic procedure: endoscope, camera, light source, signal processing unit, video monitor, insufflator and gas supply, trocars, and surgical instruments. Understanding how to use and troubleshoot this equipment is critical for any surgeon who performs minimally invasive surgery. We review the essentials of basic laparoscopic equipment, including the mechanics of normally functioning equipment and the various types of laparoscopic trocars and instruments. We also discuss robotic equipment and the fundamental differences from laparoscopy. Minilaparoscopy and single-site equipment are briefly explained. Additionally, we discuss potential technical difficulties that surgeons may encounter while performing minimally invasive procedures and provide suggestions for troubleshooting these problems. This review 13 figure, 2 tables, and 64 references.Key Words: Laparoscopy, Robotic Surgery, Minimally Invasive Surgery, Laparoscopic Surgery, Trocars, Surgical Energy Devices, Insufflator, Laparoscopic Instrumentation, Ergonomics, Single Site Surgery