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It is very important for the surgeon to be conversant with the types of laparoscopic instruments available to perform colorectal surgery. We have found it very useful to work across specialities in order to realize the entire range of instrumentation available to surgeons today, especially in bariatric surgery and gynecology. Laparoscopic instruments come in different sizes and lengths, which can be tailored to the operation in question and the patient’s body habitus. The most common instruments are 5 mm in diameter and 35 to 45 cm in length. For tall and morbidly obese patients, longer bariatric instruments should be available. This chapter describes the most common instruments that are routinely available on the colorectal surgery tray for every laparoscopic operation. Of course, apart from these instruments, multiple specialized and procedure-specific instruments are available to surgeons. Figure 5-1 illustrates the instruments on a basic laparoscopic tray for colorectal surgery.
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Every surgeon and surgical trainee should be familiar with the following instruments or the equivalent:
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Atraumatic graspers: In our practice, we most commonly use the atraumatic bowel grasper and the laparoscopic Babcock forceps to handle the colon, small intestine, mesentery, appendices epiploicae, omentum, and retroperitoneum. It is important to understand that the atraumatic bowel grasper tends to slip more often than the Babcock, which can be frustrating at times, but for this very reason, it tends not to tear the tissue. The Babcock has a better grasping ability but requires some operator experience regarding how much traction can be safely placed by the surgeon without tearing tissue.
Crushing/traumatic graspers: These are important for holding fibrous or kneeling tissue such as scar or fascia, and they can also be used to hold the specimen for extraction. They typically have locking mechanisms so that tissue can be held in place without slipping, for example, Davidson and Geck (D&G) forceps.
Needle drivers: Laparoscopic needle drivers are available in many configurations, with different gripping and release mechanism styles, and the surgeon should choose the one that works best for them.
Monopolar scissors: Our tray typically has a 35-cm monopolar scissors with a trigger mechanism for activation. Foot-activated monopolar scissors are an alternative.
Sealing device: We prefer the blunt-tip LigaSure device for sealing blood vessels. There are many devices available, and surgeons should choose the one with which they are most familiar and have the most experience using.
Laparoscopic suction irrigator.
Laparoscopic staplers should be available as needed in varying lengths and for different tissue thicknesses.
Maryland grasper: This is a tissue forceps that functions like the DeBakey forceps or the hemostat in an open operation (i.e. ...