Laparoscopic lens fogging: solving a common surgical problem in standard and robotic laparoscopes via a scientific model

Todd G. Manning, Nathan Papa, Marlon Perera, Shannon McGrath, Daniel Christidis, Munad Khan, Richard O’Beirne, Nicholas Campbell, Damien Bolton, Nathan Lawrentschuk

Laparoscopic lens fogging (LLF) hampers vision and impedes operative efficiency. Attempts to reduce LLF have led to the development of various anti-fogging fluids and warming devices. Limited literature exists directly comparing these techniques. We constructed a model peritoneum to simulate LLF and to compare the efficacy of various anti-fogging techniques. Intraperitoneal space was simulated using a suction bag suspended within an 8 L container of water. LLF was induced by varying the temperature and humidity within the model peritoneum. Various anti-fogging techniques were assessed including scope warmers, FRED(TM), Resoclear(TM), chlorhexidine, betadine and immersion in heated saline. These products were trialled with and without the use of a disposable scope warmer. Vision scores were evaluated by the same investigator for all tests and rated according to a predetermined scale. Fogging was assessed for each product or technique 30 times and a mean vision rating was recorded. All products tested imparted some benefit, but FRED(TM) performed better than all other techniques. Betadine and Resoclear(TM) performed no better than the use of a scope warmer alone. Immersion in saline prior to insertion resulted in decreased vision ratings. The robotic scope did not result in LLF within the model. In standard laparoscopes, the most superior preventative measure was FRED(TM) utilised on a pre-warmed scope. Despite improvements in LLF with other products FRED(TM) was better than all other techniques. The robotic laparoscope performed superiorly regarding LLF compared to standard laparoscope.