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Taking the Frustration Out of a Foggy Lens

Trialing an in situ lens cleaning option that reduces both time and stress in the OR

By Matthew Brunson Martin, MD, FACS
Surgeon, Central Carolina Surgery, PA, Greensboro, North Carolina

Impaired visibility is a major frustration during laparoscopic surgery. Blood, smoke and steam impair our view, and we can’t safely continue with surgery until we remove the telescope, clean it and re-insert it to the same location so we can pick up where we left off. It’s time-consuming. In long procedures, we might clean the scope 5-10 times, taking 2-3 minutes for each cleaning and reinsertion, thus adding 10-30 minutes.
These challenges are most evident during difficult cases. For example, during gastric bypass on an obese patient, it is difficult to remove and reinsert the scope. Gallbladder removal produces a great deal of steam, so we frequently need to clean the lens during that procedure.
Inefficiency is a problem, but for me, the biggest frustration is the loss of focus. Often, as I’m concentrating on a challenging part of a procedure, a greasy mist or smear of blood blocks my view. I need to interrupt the procedure not only for a few minutes of cleaning, but also for me to try to get back to the same position and refocus on a difficult task. Adding to the tension, if I have a camera operator who isn’t very experienced with the equipment, it can take longer to complete the cleaning and reinsertion. The whole process is exasperating.
Industry has worked to improve the cleaning process. A povidone-iodine surgical scrub solution helps prevent fogging and repel liquids. Other cleaning options like Fog-Guard (Xodus Medical), Fred (Medtronic), and Mr. Clear (Key Surgical) do the same. We’ve used prepackaged cleaning tool kits like the Clearify Visualization System (Medtronic) and the LaparoVue Visibility System (Buffalo Filter) to help technicians work more efficiently.
Recently, I trialed ClickClean (Medeon Biodesign) a device that covers the scope’s lens with a transparent, biocompatible film. During surgery, the surgeon clicks a trigger to advance the film along the scope, thus providing clear visibility without removal and cleaning. I appreciated the system’s in situ approach, which lets me maintain focus on the task in front of me. As soon as the view became foggy or smeared, it was cleared in a few seconds with a click or two of the device.
Because I controlled the device, I didn’t need to rely on a camera operator to restore visibility, which meant the camera operator’s experience was no longer a factor in how smoothly and efficiently the surgery proceeded. It was a more relaxed experience. We also saved all the time typically spent performing multiple cleanings and reorientations.
The shorter surgery time is better for our patients, and in situ cleaning dramatically improves my experience as a surgeon. It’s a more relaxed approach for everyone in the OR. Hospitals will see the benefits as well because it saves OR time. I think that in situ cleaning will become the norm and remove a lot of time and frustration from laparoscopic surgery.
The content presented on this page is provided for informational and/or educational purposes. This material represents the views and opinions of its authors and should not be construed as representing or reflecting the official position, views or opinions of the Society of Laparoendoscopic Surgeons. The authors of the work are solely responsible for its content.

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