,"Analysis of surgical smoke produced by various energy-based instruments and effect on laparoscopic visibility." Journal of Endourology.21,3. 347-351. (2007 ABSTRACT Purpose:We analyzed the smoke plume produced by various energy-based laparoscopic instruments and determined its effect on laparoscopic visibility. Materials and Methods:The Bipolar Macroforceps, Harmonic Scalpel, Floating Ball, and Monopolar Shears were applied in vitro to porcine psoas muscle. An Aerodynamic Particle Sizer and Electrostatic Classifier provided a size distribution of the plume for particles Ͼ500 nm and Ͻ500 nm, and a geometric mean particle size was calculated. A Condensation Particle Counter provided the total particle-number concentration. Electron microscopy was used to characterize particle size and shape further. Visibility was calculated using the measured-size distribution data and the Rayleigh and Mie light-scattering theories.Results: The real-time instruments were successful in measuring aerosolized particle size distributions in two size ranges. Electron microscopy revealed smaller, homogeneous, spherical particles and larger, irregular particles consistent with cellular components Conclusions: Surgical smoke is composed of two distinct particle populations caused by the nucleation of vapors as they cool (the small particles) and the entrainment of tissue secondary to mechanical aspects (the large particles). High concentrations of small particles are most responsible for the deterioration in laparoscopic vision. Bipolar and ultrasonic instruments generate a surgical plume that causes the least deterioration of visibility among the instruments tested.

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Currently available less than 9Fr flexible ureteroscopes remain fragile instruments. The DUR-8 Elite and Olympus URF-P3 proved to be the most durable devices.

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