Effective irrigation/suction system is essential for any laparoscopic procedure. Although assembling an irrigation/suction system from common operating room supplies is possible,12 we do not believe such a system can be usefully employed under certain difficult situations occasionally encountered during laparoscopic colorectal surgery. We recommend using an electrically driven high-flow irrigator with its probe connected to a regular adjustable suction system (Figure 2.7). Even in cases of unforeseen bleeding or spillage of intestinal contents,
this device works reliably and satisfactorily both to rapidly irrigate and to effectively evacuate fluid or other material, and a variety of cannula sizes (5-10 mm) may be chosen.
A cheaper alternative is a 2- to 5-L plastic bag with saline solution on which constant pressure is applied.
The view through the laparoscope may not only be impaired by blood or smoke on the lens, but also by fog. To prevent fogging after intraperitoneal insertion, the laparoscope should be adequately warmed (37° to 40°C) before intraperitoneal insertion. Although a warm saline bath can be used to keep laparoscopes warm until needed, specially designed warmers for laparoscopes are more suitable for routine use.
Special antifogging solution can be also effective to prevent fogging. Several types of products are commercially available. To achieve the best results, combined use of warmers and antifogging solution is recommended.
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