Constant high-level visual acuity during total laparoscopic hysterectomy using the OpClear

BACKGROUND

Operative vision can frequently be critically reduced during laparoscopic surgery by condensation and other matter accumulating on the distal laparoscope lens. By delivering saline and carbon dioxide across the lens, the OpClear system is designed to maintain operative vision without needing scope removal for lens cleaning. This study evaluates the system's efficacy in providing high-level visual acuity during laparoscopic hysterectomy while examining its utility through its impact on operative duration.

METHODS

A retrospective audit compared efficacy and utility for the three years before and after the implementation of OpClear in a single unit. Thirty-three cases were reviewed pre-OpClear, while 82 cases were analysed in the post-OpClear group. All cases involved routine total laparoscopic hysterectomies (TLH) performed by the same surgeon (AT) with similar complexity levels.

RESULTS

The OpClear system provided a consistently high level of visual acuity throughout the laparoscopic procedures. Scope removals, which typically result in non-productive operating time, were virtually eliminated. Consequently, in highly comparable cases, OpClear usage resulted in a 17-minute reduction in operating time over cases performed without the device. Additionally, in the OpClear group, there were trends towards reduced blood loss and shorter hospital stays, with patients in the OpClear group being discharged on first rather than second postoperatively.

CONCLUSIONS

The findings of this audit suggest that the OpClear system provides continuous high-level vision during laparoscopic hysterectomy. Further, reducing periods of non-productive time associated with scope removal for cleaning resulted in shorter operating times. Thus, the system has the potential to enhance safety, improve theatre utilisation and alleviate some of the surgical stresses associated with laparoscopic surgery.

Keyhole (Laparoscopic) surgery is often better for patients than open surgery as it speeds up recovery and return to normal activities. However, despite technical advances, the surgeon’s view during keyhole operations may be lost by condensation and tissue material sticking to the lens of the laparoscope, the instrument used to see inside the body. For safety, such vision loss demands that operations must be paused so the ‘scope’ can be removed and the lens cleaned. This may occur often during an operation, interrupting its progress. Our audit reviews OpClear, a device that cleans the lens while the scope is in the body, improving vision and reducing pauses. OpClear works by blowing gas and fluid across the lens, washing away contamination. In keyhole hysterectomy operations, OpClear maintained vision and shortened the length of operations. OpClear may lead to safer, shorter keyhole operations and help improve the efficiency of operating departments.