Equipment instructions

The equipment
  • Non instrument equipment

    Camera with cable (coming out of cold sterilisation)

    Light source with light cable inserted

    Screen, carbon dioxide insufflation and camera box on a stack. Out of view are the light source and cautery boxes.

    Carbon dioxide insufflator

  • Surgical instruments

    Endotip cannulae

    Veress needle

    Babcock forceps

    Laparoscopic metzenbaum scissors

    Laparoscopic cautery forceps (bipolar above, Robi combined forceps and scissors below)

  • Extra required

    Small surgical kit

    Hook or suture for securing tissue

    Syringe, needle and local anaesthetic

Cleaning
  • Introduction

    – This is a set of instructions based on Karl Storz equipment required to perform a two-port laparoscopic ovariectomy
    – Instruments are cleaned in enzymatic solution. Products can vary, so follow the manufacturer’s recommendation
    – Place the enzymatic solution in a tray for cleaning
    – Need second tray with distilled water for rinsing. Tap water cannot be used as it can leave mineral deposits.

  • Cleaning in 2 parts

    Part 1 includes:
    – camera cables
    – light source cable
    – cautery cable
    – carbon dioxide tube
    – camera head

    Part 2 includes:
    – scissors
    – babcock forceps
    – cautery
    – 2 black sheaths (of the scissors and babcock forceps)
    – 1 cautery sheath
    – veress needle
    – 2 black handles
    – 1 cautery handle
    – hook (if using)
    – and 2 cannulae

  • Part 1

    Includes:
    Camera cables, light source cable, cautery cable, carbon dioxide tube and camera head

    – Cables and carbon dioxide tube are placed in enzymatic solution and left to soak
    – Important: do not emerge camera cable end that plugs into machine. Wrap this in tissue and leave hanging outside of tray
    – Use a cloth to clean the cables and carbon dioxide tube
    – Place in distilled water to rinse
    – Dry cables and carbon dioxide tube before packing

  • Part 2

    Includes:
    Scissors, babcock forceps, cautery, 2 black sheaths (of the scissors and babcock forceps), 1 cautery sheath, veress needle, 2 black handles, 1 cautery handle, hook and 2 cannulae

    Instruments are also placed in enzymatic solution for 10 to 30 minutes to soak (depending on the solution you use)

    1. Remove scissors, babcock forceps and cautery from sheath and place in tray in separate bits
    2. To remove cautery from sheath press button on top of handle, hold onto end of cautery and gently remove from sheath. Remove handle from sheath (screws onto sheath)
    3. To remove scissors and babcock forceps from sheaths, remove handle by pressing button on top and pull off. While holding the instrument end twist and pull instrument from sheath
    4. Veress needle screws apart from sheath
    5. Remove pin from cannula, pop of rubber tip, twist top of the cannula off from body and place into tray in separate bits

    – Scissors and babcock forceps ends can be cleaned using a small toothbrush
    – Cautery end is cleaned using a small toothbrush.
    This can be easily broken if bent, so be careful. Hold onto black plastic tips to stop end from bending as will weaken the ends or keep cautery in sheath whiles cleaning

    – Clean inside the ports using a pipe cleaner or ET tube cleaning brush
    – Flush through cannulae, and scissor and babcock forceps inserts with enzymatic solution
    – Hook, handles, outside of cautery, babcock and scissor inserts can be cleaned using a cloth

    – Place everything into distilled water to rinse
    – Flush through ports and instrument sheaths again with distilled water

Packing
  • Introduction

    This is only one example for packing the equipment for sterilisation. Equipment inventory, size of equipment and sterilisation options will vary. Always contact your manufacturer for appropriate guidelines.

  • Pack 1

    – Carbon dioxide cable
    – Cautery cable
    – Scissors handle
    – Babcock forceps handle
    – Cautery handle
    – Place in large autoclave bag and double bag

  • Pack 2

    – Hook if using. Place swab over end of hook and tape in place as it is sharp
    – Veress needle. This can be placed back into its sheath, but don’t screw on tightly so steam and penetrate all parts
    – Cautery, scissors & babcock forceps, and their respective sheaths
    – Leave cautery, scissors and babcock forceps separate from sheaths
    – 2 cannulae. Put the cannulae back together, but leave loose as for veress needle

Opening the surgical packs
  1. Drapes

    Table drape

    Large patient drape

  2. Basic surgical kit items

    Small surgical kit, including towel clamps

    No. 11 scalpel blade

    2.5ml syringe and ¾ inch 24g needle

    Local anaesthetic (bupivacaine) – hold upside down if using pre-opened bottle

  3. Laparoscopy instruments

    Babcocks, metzenbaum scissors, cautery (handles, sheaths, inserts of each). Also, hook if using.

  4. Laparoscopy cables and tubes

    Cautery cable, insufflation tube

  5. Cold sterilised equipment

    Pick up cold sterilised telescope within sheath and cold sterilised light cable (assistant will have drained, then rinsed with warmed sterile water)

    Pick up cold sterilised camera and cables, ensuring that the plug is left untouched. The assistant will pick up the plug, unwrap any covering if present and walk to the tower to plug it in.

Putting Together the Instruments
  1. Endotip cannulae

    Screw the top on each port using firm pressure. Check seals are intact and in place. Check screw on gas valve is tight and close the valve.

    Remove pin and you can place this under the kit drape.

  2. Veress needle

    Screw both parts together.
    Check screw on gas valve is tight.
    Check spring action is working.

  3. Babcock forceps

    Babcock forceps into black outer casing. Once inserted twist the Babcock end 90 degrees to lock in place.

    Attach black handle on to the end – should just click into place. Use the handle with the ratchet to allow forceps to be locked in place.

  4. Metzenbaum scissors

    Close scissor jaws with fingers. Insert scissors into black outer casing, as with babcock forceps. Twist the end 90 degrees once inserted to lock in place.

    Attach black handle (the one without the ratchet) Has dial on handle to allow scissors to be oriented during surgery.

  5. Bipolar cautery

    Screw outer casing (silver) onto the cautery handle – must be done first before inserting forceps.

    Gently close the delicate cautery tips together with finger and thumb.

    Push button on top of handle and gently insert the cautery forceps insert into the outer casing and click into place. Don’t force the cautery insert.

  6. Camera

    Clip camera onto the telescope and attach the light cable.

    Turn on the light source, increase the intensity to at least 75% and white balance against a white swab.