Solving the problems of gas leakage at laparoscopy

Abstract

Gas leakage during minimally invasive surgery is an aerosolization hazard. Sensitive optical and thermographic imaging can demonstrate and differentiate between mechanistic categories, enabling engineering solutions to fortify surgical care against pollutants and pathogens affecting operating room teams. Areas for improvement.

Fig. 1

Photographic stills from video capture of high‐speed Schlieren imaging during laparoscopic surgery showing examples of each category of gas leak a,b Category 1 intentional leak owing to venting gas from trocar to clear smoke (a) and removal of a trocar without first desufflating pneumoperitoneum (b). c Category 2 inadvertent leak occurring at abdominal wall around trocar base. d–h Category 3 inbuilt leak occurring through the trocar, as happens during optical port insertion (d) and removal of an obturator from a 5‐mm port (e) and from a Hassan port (f), or because of leakage via valves at the time of insertion (g) or removal (h) of an instrument. Best viewed in Video S2 (supporting information).