Holding the Endoscope Unit

Practice holding the camera and find a comfortable position. One hand should always be holding the camera head and the coupler. Be careful not to turn the zoom dial or the focus dial.

Place that second hand either on the camera head on the endoscope.

Practice holding the camera as steady as possible. Even slight movements cause the monitor image to shake resulting in the sea-sickness phenomenon.

Make sure the light cord that attaches to the endoscope is screwed on tightly.

The light cord is an excellent marker of the orientation of a 30 degree endoscope. It will tell you if you have rotated the endoscope.

Since the light cord is relatively heavy, it will tend to rotate down.

Sometimes, the surgeon may ask you to rotate the light cord down to change the operative field.

The Camera Cord

The camera cord should ALWAYS be down. That is the marker to let you know that the camera has not been rotated.

The writing on the camera head should be up towards the ceiling, i.e. you should be able to read it.

View

Most laparoscopic procedures use an angled scope, usually at 30 degrees.

That means that when you point the endoscope straight on an object, instead of getting that same view, the monitor image will show you what is slightly below the image.

So if you want to get an object in centered and full view on the monitor, aim the endoscope slightly higher than the image.

Zoom

After you found a comfortable position to hold the camera, practice manipulating the blue zoom dial.

Clockwise is to zoom out.

Counterclockwise is to zoom in.

A common request from the surgeon is to "Back up". This can be accomplished by either physically moving the endoscope unit back, or by zooming out. Usually, the surgeon wants you to physically move back.

Focus

Practice focusing with the gray dial. You should not use this too often.

See the troubleshooting section if you have problems focusing.

Once the Surgery Starts

Always follow the surgeons' instruments in and out of the abdominal cavity, including when they are taking out instruments. They need to be able to see the path in and out.

Always keep the camera centered on where the surgeons are working.

Many students get very confused when the light cord accidentally rotates because that changes the operative field (anterior becomes posterior, posterior becomes anterior). Be aware of the movements of the light cord. You can feel the grooves on the camera head in order to know if the camera cord is down.

Rule of Opposites

The"Rule of Opposites" happens because the laparoscope is manipulated on a fulcrum.

It may be helpful at this point to practice by using a utensil like a pen and try to manipulate the tip of the pen by moving the base.

If the surgeon asks you to MOVE RIGHT, move your hand to the LEFT. That will make the endoscope see a right image.

If the surgeon asks you to MOVE LEFT, move your hand to the RIGHT. That will make the endoscope see a left image.

If the surgeon asks you to MOVE DOWN, move your hand UP.

If the surgeon asks you to MOVE UP, move your hand DOWN.

Rule of Opposites

R=L
L=R
U=D
D=U

This concept is key. Click here for a simple game to practice these movements.

Pearls from the well-known Surgical Recall, Lorne H. Blackbourne, M.D.

Tips for Driving the Camera

1. Keep the camera centered on the action

2. Watch all trocars as they come into the peritoneal cavity (and the tissues beyond, so they can be avoided)

3. Watch all the instruments as they come through the trocars (unless directed otherwise)

4. Ask before removing the camera to clean (aka re-FRED) the lens

5. Look outside the body at the trocars and instrument angles to reorient yourself

6. Keep the camera oriented at all times (i.e., up and down); usually the camera cord is on the bottom of the camera--- orient yourself to the camera before entering the abdomen

7. You may clean the camera lens at times by lightly touching the lens to the liver or peritoneum

8. Never let the camera lens come into contact with bowel because the lens may get very hot and you can burn a hole in the bowel!

9. Put your helmet on (i.e. expect to get yelled at!)

10. Never cop an attitude when the surgeons are a little abrupt (e.g. "Center---center the camera!")

11. Always watch the trocars as they are removed from the abdominal wall for bleeding from the site and view the layers of the abdominal wall looking for bleeding as you pull the camera trocar out at the end of the case.