graspers and dissec-
tors at the ends of
micro tools may not
be sturdy enough to
move thick tissue or
anatomy. With heav-
ier tissue, smaller
instruments are bet-
ter at pulling than
pushing. As such, in
some micro-lap pro-
cedures, you may
also need to augment with standard-sized tools that require larger
incisions. For example, for suturing you still need a trocar you can fit
a needle through (unless you pass the needle through the abdominal
wall, which can be tricky). With many micro procedures, I end up also
using some larger trocars, either to take something out or to put
something in.
Creating comfortable handles seems to be another challenge. But in
an increasingly competitive arena, manufacturers are also working to
make handles more comfortable by, among other things, providing
micro-sized instruments that attach to standard-sized lap handles.
Although there's a significant capital expense associated with instru-
ment sets that contain the complete array of smaller tools, in the long
run micro-laps can save money, because unlike standard disposable
trocars, micro-lap ports are reusable.
One other caution: I don't do much cleaning of instruments, but I rec-
ognize that smaller instruments may be more challenging to clean and
service than standard instrumentation. The channels are tiny, so finding
small enough brushes can be a challenge, as can adequate flushing.
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O U T P A T I E N T S U R G E R Y M A G A Z I N E O N L I N E | S E P T E M B E R 2 0 1 5
z QUICK STUDY The learning curve for using smaller
microlaparoscopic instruments is modest for anyone
already well versed in conventional laparoscopic surgery.
Pamela
Bevelhymer,
RN,
BSN
