Advances in laparoscopic instrumentation

Introduction

Since the emergence of laparoscopic cholecystectomy in the later 1980s and its subsequent wide application, there has been an explosion of technical refinements and new instrumentation in laparoscopy. This review outlines recent advances in instrumentation and technology for each stage of a laparoscopic procedure. These developments which range from innovative access techniques to novel instruments for reconstructive cases, are making laparoscopic procedures easier for physicians to perform and safer for patients.

Discussion

At the end of a laparoscopic procedure, safe closure of the anterior fascial layer at each trocar site (>10 mm) is necessary to prevent herniation. Various needle systems are now available for this purpose. One example is a needle passer developed by Carter and colleagues (Carter-Thomason device, Inlet Medical Inc., Eden Prairie, Minn.) that acts as both a needle and grasper. The device introduces the suture through the fascia, drops the suture, picks it up on the other side of the wound, and is withdrawn grasping the suture.

Conclusion

In the past 5 years, many different laparoscopic procedures have been shown to be effective and now are an accepted part of urologic practice. Progress in laparoscopy has been facilitated by rapid developments in technology, namely microprocessors and instrumentation. Continued advancements will simplify surgical techniques and expand the applications of laparoscopy in urology.