* Impaired Laparoscopic Vision
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# Category: Clinical Data
# **Clinical Data**
A Gynaecological Case Report Using a Unique Laparoscope Lens Cleaning Device OpClear®
22 Aug 2024
During challenging laparoscopic procedures maintaining clear vision is critical to the outcome – A Gynaecological case report using a unique Laparoscope lens cleaning device OpClear®
A 44 year para 1 (LSCS) old woman presented to her GP with sudden onset and worsening pain in her right iliac fossa. She was referred to the oncall surgical team with a suspected diagnosis of a perforated appendix. A subsequent CT of the abdomen & pelvic revealed an inflammatory mass in the right adnexa which appeared to be related to the ovary (figure1). The appendix was seen superiorly to this abnormality and appeared normal. She was then referred to the oncall gynaecology team with a diagnosis of a right tubo-ovarian abscess. The oncall team commenced her on intravenous antibiotics and requested a pelvic ultrasound. A transvaginal scan was undertaken but was difficult given the patient’s body mass index of 53 (weight 131kg). Nonetheless the sonographer reported a 76mm complex cystic structure (figure2), with a medium to large amount of free fluid in the pouch of Douglas (POD). The uterus and left ovary were reported as normal. After 24 hours the patient was switched to oral antibiotics, she continued to improve clinically and was subsequently discharged home.
Of note, earlier in the year she had been referred for investigation and management of her heavy menstrual bleeding. She was keen to pursue surgical options but given her morbid obesity, she was advised that this would only be possible if she lost a significant amount of weight. One week following her discharge she was re-admitted with a recurrence of right iliac fossa pain. A repeat pelvic ultrasound revealed an increase in size of the pelvic mass to 86x50x92mm, again with free fluid but this time low level mobile echoes were also visible (figure 3). After discussions with microbiology she was once again commenced on intravenous antibiotics but to be continued for 10 days. If after 10 days a further pelvic ultrasound showed no change in size, she was to be booked for elective surgery.
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Ten days later she was clinically well, but a repeat ultrasound suggested no change in the size of her adnexal mass. She was therefore booked for elective surgery and consented for a laparoscopic and or open incision and drainage of her tubo-ovarian abscess. However she was very insistent that if at all possible could her “womb be removed at the same time”, as her family was complete and her periods were “terrible”. She was therefore consented for a total laparoscopic hysterectomy and removal of fallopian tubes and right ovary.
Under general anaesthesia, a 20mm pneumoperitoneum was created with a standard verres entry technique. A 12mm trochar was then inserted into the umbilicus to facilitate the use of the OpClear® device with a 10mm zero degree laparoscope. The OpClear® was primed prior to insertion into the abdomen. Given the patient’s morbid obesity the anaethestist was reluctant to have a steep trendelenberg “head down” position, because of the increase in ventilation pressures. This further increased the technical complexity of laparoscopic surgery. Despite the difficulties insertion of the laparoscope into the abdomen revealed a right tubo-ovarian mass, with a large pseudocyst and fluid in the POD. To facilitate the surgery and retract the bowel, four 5mm ports (two in each lower quadrant) were inserted. The right adnexa was mobilised with blunt dissection and utilising the Thunderbeat TM device. The Opclear® significantly and consistently maintained good surgical acuity. With the adnexa excised the decision was taken to go on and perform a total laparoscopic hysterectomy as per the patient’s request. This was only made in the context of a reliable surgical field of view. Given the adiposity, proximity of the bowel, adhesions from the previous LSCS , this was a high risk procedure, with potential bowel, bladder and ureteric complications.
The dissection of the left adnexa and reflection of the bladder was unremarkable, however the right uterine artery started to bleed when divided by the Thunderbeat TM device. It retracted. Once again good surgical acuity provided by the OpClear® device facilitated identification of the bleeding vessel and the adjacent anatomy. Once haemostasis was secured a colpotomy was performed, the uterus and specimen were removed vaginally and then the vault was closed with intracorporeal laparoscopic suturing using the Stratofix TM suture. As a precaution given the proximity of the right ureter a retrograde pyelogram was performed. This showed good fill and spill with no suggestion of ureteric compromise.
Post operatively, the patient made an unremarkable recovery and went home 48 hours later.
## Patient’s view
“As soon as I woke up, I had no pain in the right side, it was heaven. I’m so grateful. I’m over the moon. I’ve had three years of agony and pain from my periods, affecting my life, work and relations with my husband. I feel I’ve been given a new lease of life.” Mrs SE
## **Surgeon’s view**
“This was technically challenging surgery. The patient’s morbid obesity significantly complicated the surgery. Without a constant clear image created by OpClear®, I would not have had the confidence to proceed with a total laparoscopic hysterectomy. In my opinion the improved surgical acuity delivered by the Opclear® device significantly reduced the risk of conversion to
an open procedure. Conversion to laparotomy would have increased the patient’s risk of w
ound infection, venous thromboembolism, a longer in patient stay and a much longer return to normal activities. This is an excellent example of medical device innovation, delivering real quality improvements for the patient, the hospital and commissioners of healthcare.” Mr A Alexander Taylor, Consultant
### Read More
Constant High-Level Visual Acuity During Total Laparoscopic Hysterectomy Using the OpClear® System
22 Jul 2024
Journal of Obstetrics and Gynaecology
ISSN: (Print) (Online) Journal homepage: www.tandfonline.com/journals/ijog20
R. Evans & A. Taylor
To cite this article: R. Evans & A. Taylor (2024) Constant high-level visual acuity during total laparoscopic hysterectomy using the OpClear®
system, Journal of Obstetrics and Gynaecology,
44:1, 2375590, DOI: 10.1080/01443615.2024.2375590
To link to this article: 
**View the full clinical study here: **
Clinical Papers and Testimonials Summary April 2024
22 Apr 2024
## View Our Clinical Papers and Testimonials Summary April 2024
Abstract: Stop the Smudge: A Novel Solution to Loss of Vision During Laparoscopic Colorectal Surgery
25 Aug 2022
**Title:** Stop the Smudge: A Novel Solution to Loss of Vision During Laparoscopic Colorectal Surgery
**Authors:**Ozgur, Ilker MD; Liska, David MD; Valente, Michael A. MD; Steele, Scott R. MD; Gorgun, Emre MD
**Published:**Surgical Laparoscopy, Endoscopy & Percutaneous Techniques: August 25, 2022 – Volume – Issue – 10.1097/SLE.0000000000001091
**Background:**
An obscured vision of surgical field during laparoscopic surgery is inconvenient. Several temporary methods were described as solutions to loss of vision, and common practice is scope removal, cleaning, and heating. A lately developed and introduced device claims continuous clear vision during laparoscopic surgery. This study aims to present our initial experience with the device during laparoscopic colorectal surgery.
**View the full abstract here:**<
**Download the full article here:** <
Retrospective Study of Operating Efficiency in Laparoscopic Hysterectomy Using the OpClear® System
24 Aug 2022
**Title:** Retrospective study of operating efficiency in laparoscopic hysterectomy using the OpClear® system
**Authors:**Evans R, Taylor A
**Published:** Poster presented at RCOG 2022
Stop the Smudge: OpClear®, a Novel Solution to the Loss of Vision During Laparoscopic Colorectal Surgery.
23 Aug 2022
Authors: Ozgur I, Liska D, Valante M, Steele S, Gorgun E.
Published: Poster presented at SAGES 2022.
OpClear®: Ensuring clarity, Control & Continuity During Laparoscopic Surgery
22 Aug 2022
Title: OpClear®: Ensuring Clarity, Control & Continuity during Laparoscopic Surgery.
Authors: King T, Newell A.
Published: Poster presented at SAGES 2022.
Cost of Operating Room Time is $46.04 Dollars Per Minute
22 Jul 2022
**Objectives:** The purpose of this study is to establish a consensus estimate of operating room cost per minute based
on currently published literature.
**Design:** Literature review.
**Main outcome measurement:** Operating room cost per unit
of time.
**Results and conclusions:** A Google Scholar search produced 51 articles regarding “operating room cost per minute,” of which 14 had novel estimates for OR cost per minute. The mean of these estimates was $46.04 ± $32.31. There was little consistency in methodology among the included articles, which is reflected in the large range of values.
**Level of Evidence:** IV; Review
**Keywords:** Business, management, human resources, cost,
value, and efficiency.
(J Ortho Business 2022; Volume 2, Issue 4: Pages 10-13)
****
Effective Cleaning of Endoscopic Lenses to Achieve Visual Clarity for Minimally Invasive Abdominopelvic Surgery: A Systematic Review
11 Oct 2020
## Effective cleaning of endoscopic lenses to achieve visual clarity for minimally invasive abdominopelvic surgery: a systematic review
Ahmad Nabeel1,2,3 · Salman K. Al‐Sabah3,4 · Hutan Ashrafan1,2
Received: 11 October 2020 / Accepted: 17 April 2021 © The Author(s) 2021
## Abstract
**Objective:** To review the recently available interventions to achieve optimal visual clarity in laparoscopic abdominopelvic surgery compared to conventional cleaning alternatives. Summary background data Currently, there is no consensus on the most effective method for the cleaning of endoscopic lenses used in minimally invasive abdominopelvic surgery.
**Methods:** Literature searching for articles relevant to answering a predefined research question was performed in December 2019 and involved searching of the electronic databases of MEDLINE, the Cochrane Registry, and EMBASE. Basic search terms were derived using the PICO (population, intervention, comparator, and outcomes) framework and through a scoping search of literature via MEDLINE. A manual search of Google Scholar and citation screening of eligible studies was also performed to ensure the identification and inclusion of all pertinent studies to address the research question.
**Results:** Among conventional and readily available methods, the most effective approaches involved heated sterile water, heating of laparoscope lenses, and surfactant solutions, including FRED and Ultra-Stop, while evaluations of all novel devices and methods were more effective than controls, which included lens wiping systems and air and carbon dioxide flow systems. While the former surgical techniques were consistently associated with superior lens cleaning ability and/or defogging capability and subsequent optical clarity of images within the surgical field, no methods conferred any meaningful effects upon other clinically important outcomes, such as operative time, costs, complication rates and length of stay, suggesting that decision-making concerning the selection of lens cleaning method/device should suit the preferences of the instrument operator and/or the responsible surgeon.
**Conclusions:** We demonstrated that a range of endoscopic lens cleaning methods and devices could be used to achieve sufficient optical clarity of the laparoscopic surgical field by either preventing lenses from fogging and/or facilitating the inter-operative cleaning of fouled lenses. Despite the various methods evaluated in this review, there were no significant
differences in complication rates between the intervention and control groups.
**View full abstract here: **
OpClear®: Introduction to Laparoscopic Surgical Procedures
22 Aug 2020
## Introduction to Laparoscopic Surgical Procedures
This document is designed to provide the reader with a base level understanding on a range of laparoscopic procedures and how OpClear® can help the clinical team whilst performing them.
It is divided in to key speciality sub groups of;
* Upper Gastro intestinal and Bariatrics
* Hepato-Biliary and Pancreatic
* Colo-Rectal
* Urology and Kidney Transplant
* Gynaecology
* Endocrinology
* Procedures that bridge specialities
Further reading can be obtained from the Internet and or text books but there is no substitution to asking a surgical team to observe a procedure as an educational learning experience. In doing so, and whilst observing a procedure, identifying the associated benefits of OpClear® to and for the individual surgeon will make for a personal sell.
This document is work in progress. As we each build our personal experience feel free to add or comment to this educational material.
View the full PDF document here: ****
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