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1、LaparoscopicInstrumentationPatrickS.LowryINTRODUCTIONLaparoscopicinstrumentationcontinuestoevolvetowardssmaller,morereliable,andbetterergonomicdevices,withalargervarietyofchoices.Sincethefirsteditionofthistextbook,subtleimprovementsarereadilyapparentinexistingdevicesasfirst-generat
2、ioninstrumentsprogresstowardslater-generationmodels.Newtechnologyexiststoallowprocedurestobeperformedwithfewercom-plications.Combinedwithrefinementsintechniques,newandimprovedinstrumentationprovidesurologicsurgeonstheopportunitytosafelyperformmorechallengingproceduresbyalaparoscop
3、icapproach.CAMERASYSTEMSCamerasystemsstillhavethreeintegralparts:thecamerahead,thecamerasystemcontrolunit,andthemonitor.Thesesystemshaveprogressedfromanalogtodigitaltoadvancedapplicationsofdigitaltechnology(1).Mostcamerasattachtotheendofthescopetocapturetheimagecomingthroughthele
4、ns.Thisimageisthencapturedasadigitalsignalandtransferredbythecontrolunittothemonitor.Newermonitorsareflatscreenpanels.Earlyflatscreensdidnotprovideadequateimaging,butbyincreasingpixelconcentrationandsubsequentlyprogressingintohigh-definition(HD)imaging,currentmonitorssurpassprevious
5、lyavailablepicturequality.Toachievethis,significantimprovementwasrequiredinthetransferofthedigitalsignaltothemonitor.Early-generationdigitalunitssufferedfromamillisec-ondlagtimebetweenwhatwasperformedsurgicallyandwhatwasseenonthescreen.Thisdelaycanbedistracting,duetothesubtledisco
6、nnectbetweensurgeonandimage.Thecurrentunitsprocessthesignaltoanimagewithincreasedspeed,makinganydelayimperceptible.Somesystems,videolaparoscopes,employasinglecamera/scopeunit.Theseunitshaveachargedcoupleddevice(CCD),whichisaminutedigitalchipattachedtothetipofthescope(2).Theiradva
7、n-tageisimprovedpictureclarity,duetothecapabilitytocapturethepicturedigitallyatthescopetip,ratherthancapturingtheimageofthepictureafterithaspassedthroughthelensofthescope.Sincethepicturetravelsviawireinsteadofthroughalens,somescopeshavebeendevelopedwiththecapa-bilitytoflexatthetip
8、(see“Scopes”).Additionally,HDvideolaparo
