By Milsom J.W., Bohm B.
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Additional info for Laparoscopic Colorectal Surgery.Second Edition
After the bleeder is identiﬁed and secured with an atraumatic grasper, a second grasper is introduced from the other port and passed through the loop. The ﬁrst grasper is then gently released, and the second grasper grasps the bleeding point. The loop is snugged down over the shaft of the instrument, securing the bleeder. Another usage of this device is to secure the stump in laparoscopic appendectomy. After securing the stump, the device can be used as an effective retracting tool unless its string is cut.
Because the intracorporeal manipulation is more extensive and multiquadrant in colorectal procedures compared with other general surgical procedures, the device should be durable and ﬂexible so that a wide range of movement of the surgeon’s hand causes neither gas leakage nor device malfunction. 15 The precise role of hand-access devices will be described in the speciﬁc procedure chapters. 10. GelportTM hand-access device (Applied Medical, Rancho Santa Margarita, CA). 11. Various types of laparoscopic graspers: A Maryland dissector, B Bowel grasper, and C Babcock type grasper.
Therefore, the effect on tissue is thermal and depends on exposure time and the amount of energy applied to the tissue. Before embarking on a speciﬁc discussion of each instrument used to cut or coagulate tissue, reviewing some basic concepts about thermal alteration of tissue is worthwhile. 1). An increase in tissue temperature up to 60°C results in almost indiscernible changes to the naked eye. 1,2 When the tissue temperature reaches 100°C, the cell water boils, water is converted to steam, and the cell wall ruptures.