Quantifying Intraoperative Laparoscopic Visual Field Opacity.

BACKGROUND AND OBJECTIVES

Laparoscopic surgery can be complicated by condensation and debris on the lens obscuring the visual field, increasing the risk of surgical error and injury to the patient. Despite, development of possible solutions, little is known regarding the quantitative measure of time lost during surgery because of an obscured visual field. Without this knowledge, the cost of laparoscopic lens fogging cannot be quantified and compared to the cost of antifogging devices. In the present study, we investigated the amount of time a laparoscope is withdrawn for cleaning during surgery.

METHODS

This was a prospective, observational study of patients (n = 52) who underwent laparoscopic surgery at Florida Hospital Celebration Health. Patient's age, gender, and body mass index, operative time, wound class, estimated blood loss, type of procedure, and complication (if any) were collected. In addition, intraoperative information on the number of times and total amount of time the laparoscope was withdrawn because of obscured visual field were recorded.

RESULTS

Eighty-two percent (43) of the procedures required laparoscope withdrawal because of fogging. Increased operative time, increased blood loss, and patient age correlated with the number of times ( < .05) and amount of time ( < .05) the laparoscope was withdrawn.

DISCUSSION

There was a significant correlation between increased laparoscope withdrawal because of an obscured visual field with increased EBL, operative time, and patient age. Possible explanations include change in body composition with age, the increased viewing angles required for more complex procedures, and increasing intraoperative effect on the surgeon of the poor visual field caused by fogging and debris.