Page 38 - Clinical Manual of Small Animal Endosurgery

26 Clinical Manual of Small Animal Endosurgery

Disposable, reposable and reusable instruments

Many endoscopic instruments and accessories (e.g. cannulae, instru-
ments, needles) are available as pre-sterilised plastic items (disposable),
or as items intended for limited reuse (reposable) or in-clinic re-
sterilisation (reusable). Disposable items are typically manufactured from
plastic (with non-replaceable blades if necessary) and have a lower
capital cost. They are intended to be single-use items but in veterinary
practice are sometimes cleaned and reused. If this approach is chosen,
certain limitations must be recognised. Notably, such items are often
complicated in structure and cannot be disassembled. Although the
outer surfaces can be cleaned and the equipment then cold-sterilised,
it is impossible to reliably clean these instruments and therefore sterility
cannot be guaranteed. Additionally, the plastic becomes brittle with
repeated use and may unexpectedly break in use and the sharpness of
any blade will rapidly diminish.
Reusable instruments have a higher capital cost but can be taken apart
for cleaning and can be re-sterilised by autoclave. Complex instruments
(and particularly those with a lumen) are only reliably sterilised in a
vacuum (rather than gravity-displacement) autoclave, however. If they
have a blade, it may be possible to re-sharpen or replace this.
Reposable instruments are less commonly used but offer a lower item
cost than reusable items. The manufacturers specify guidelines that allow
limited reuse when cleaned and sterilised according to their instructions.
The instrument should be marked each time it is resterilised so that it is
disposed off appropriately.

The laparoscopy team

Endoscopic surgery requires a coordinated team, of which nurses and
technical assistants are an essential part. Their role is important not only
for proper care and maintenance of the equipment, but for operating-
room and equipment set-up, as anaesthesia and surgical assistants, and
to identify and solve unexpected system failures.
To improve operating-room efficiency, training before the procedure
is beneficial, as is the provision of written protocols for equipment set-
up, use and cleaning. The operating-room team should also be able to
anticipate urgent needs, such as rapid control of haemorrhage or conver-
sion to an open procedure.
Before surgery starts, the team should ensure that all the required units
(tower, suction, electrosurgery and irrigation systems) are available and
functioning properly. All the equipment and the theatre trolley are pre-
pared while the surgeons are scrubbing up; the fluid irrigation system is
then connected to the lavage solution (lactated Ringer’s solution or 0.9%
saline). At the onset of the procedure the monitor, the tower and the