SELF/Perioperative Nursing/Laparoscopy Setup

   ⚠️In Development: Module actively being built.

▼This page is a part of the Perioperative Nursing Curriculum by ECSACONM and SELFPlease see the Intuitive Foundation Terms of Use and do not edit without permission.

By the end of this module, learners will be able to set up standard laparoscopic equipment correctly and perform basic troubleshooting to ensure safe and efficient operation. They will understand the function of key components—such as the camera system, light source, insufflator, and electrosurgical units—and how to prepare the equipment for use in minimally invasive procedures.

• Describe the functions of the laparoscopic tower components and explain how proper positioning supports the surgeon’s line of sight.
• Explain safe practices for routing and securing cables and tubing to maintain sterility and prevent hazards.
• Describe the organization and safe handling of laparoscopic instruments, including passing techniques and implantable devices.
• Explain preparation, orientation, and troubleshooting of the laparoscope and camera system.
• Describe the establishment of pneumoperitoneum, smoke evacuation, and systematic methods for resolving visualization problems.
• Explain documentation requirements and immediate post-use cleaning and transport of laparoscopic instruments.

Laparoscopic surgery is a minimally invasive technique that uses small incisions, a camera, and specialized instruments to perform procedures inside the abdomen under video guidance. By creating a gas-filled working space and relying on magnified visualization, it reduces tissue trauma, pain, and recovery time compared to open surgery.

The laparoscopic tower is the central hub that houses the light source, camera control unit, insufflator, and display monitor. Before every procedure, ensure the tower is positioned so that the monitor lies directly in the surgeon’s natural line of sight, allowing both surgeon and circulating nurse to view it clearly without obstruction - typically on the patient’s right for gallbladder and left-sided colon cases, on the left for gynecologic, foregut, and bariatric procedures.

The light source, camera control unit, insufflator, and display monitor each require inspection before surgery begins. Light cables are examined for signs of damage, such as cracks or burn marks, and secured firmly into the source port. The intensity setting is kept on standby until the scope enters the patient, protecting the fibers from heat damage. The camera head is attached to the control unit, with a white balance performed against a sterile white field to ensure color accuracy.

Arrangement of tower components should support efficient workflow. Insufflators are often positioned near the top, where pressure and flow readings are visible at a glance. Camera and light source controls are placed at eye level for easy adjustment, with any data recording units situated below. Cables should be routed neatly behind the tower to prevent tripping hazards while still allowing repositioning if required. A final check involves calibration of the insufflator tubing. Air should be purged from the system, connections secured, and filters inspected for integrity. The insufflator alarms are briefly tested to confirm function, with the initial flow set low before trocar entry. Skipping this step increases the likelihood of pressure surges, under-insufflation, or unexpected alarms once the procedure has started.

Routing of cords and tubing is essential both for safety and for maintaining sterility. The light cable is best positioned at the base of the scope so that it falls naturally downward, reducing strain on the surgeon’s hand. It is secured to the drape with non-perforating clips, typically in two places, preventing the distal connector from pulling or dragging on the floor. The camera cord may be routed alongside the light cable and fixed at the same points to keep the lines organized.

Insufflation tubing is directed along the patient’s side and secured at the drape edge, usually with a towel clip. A small loop is maintained near the trocar site to provide slack, preventing the tubing from tugging during patient movement or instrument manipulation. Smoke evacuation lines, if required, are routed separately on the opposite side of the operative field, avoiding congestion and making troubleshooting easier. Electrical cords from the tower and any ancillary equipment are routed behind the tower itself and taped in straight lines along the floor. When cords must cross walking paths, protective covers are placed over them to reduce tripping risk. Loops and snags are carefully avoided, as these can catch on instrument handles or staff clothing. Cable length is verified in advance to allow tower repositioning without accidental disconnections.

Before the first incision, a “cord sweep” is performed. This quick review ensures that every connection is secure, all cables are routed in predictable paths, and none rest against heat-generating components such as the light source. The sweep also confirms that no cable interferes with the sterile field or foot pedals, allowing the procedure to begin with a clean, organized setup.

Setting up laparoscopic instruments requires careful sequencing. On the Mayo stand, trocars are arranged in order by size—5 mm, 10 mm, and 12 mm—while bladed and bladeless options are separated for clarity. Graspers, dissectors, and scissors are placed in the order they are typically required, supporting a smooth progression from access to exposure, dissection, and control. Clip appliers and staplers are kept in a separate sterile tray, with reload cartridges sorted by size and color to reduce confusion.

When passing instruments, the scrub nurse presents them by the shaft, with jaws closed and handles angled for a natural grip. Instruments are identified aloud by name—such as “atraumatic grasper” or “Maryland dissector”—before passing. Anticipation plays a central role, and the nurse often has the next likely instrument in hand during complex dissection steps. Care is taken not to twist instrument cables with the camera cord, as repeated torque can degrade insulation and compromise performance.

Implantable devices and clip appliers require particular attention. Clip cartridges are preloaded but not armed until requested by the surgeon. A second clip applier or stapler is usually kept ready, with the safety lock engaged until handover. Device misfires frequently stem from improper loading or use beyond the intended cycle, so careful preparation and immediate availability of a backup device help reduce the risk of intraoperative delays. As instruments are used, visible soil such as blood or fat is gently wiped away with sterile gauze moistened in sterile water, helping maintain visibility of tips. Sharp items, including scissors and suture needles, are passed using a neutral zone technique to reduce glove puncture risk. At the close of the case, instruments are counted, disassembled where possible, and arranged with jaws open for transport to sterile processing.

Self-Assessment

Please complete the following: Quiz 1: Laparoscopy Setup - ECSACONM

Preparation of the laparoscope begins with inspection of the lens for chips, scratches, or condensation within the optics. The camera head is attached and oriented so that the surgeon’s preferred scope angle—whether 0° or 30°—is clearly identified. A white balance is performed, and the focus checked on a clean, well-lit field. The image horizon is adjusted by rotating the camera head until horizontal features appear level on the monitor.

During the procedure, the assistant holding the scope must keep the target anatomy centered and the horizon stable. With a 30° scope, adjustments are usually made by gentle rotation rather than trocar repositioning, which helps maintain pneumoperitoneum. When condensation or smoke obscures the view, the scope is withdrawn, wiped with anti-fog solution, and reinserted promptly to restore clarity. Horizon adjustments requested mid-case are performed by rotating the camera head, rather than twisting the light cable, which risks damaging the fiberoptic strands. The connection at the light source is checked periodically, as a loose fit can cause dim or yellowed images. Between uses, the scope is rested in a secure holder rather than on drapes, where moisture may collect and interfere with visibility. If visualization problems arise, a structured approach helps identify the cause. Monitor connections are reviewed first, followed by brightness settings on the light source, then bulb function if dimming persists. Familiarity with quick exchange of a failing camera head ensures that sterility is preserved and operative delays minimized.

Preparation for insufflation begins with inspection of the CO₂ cylinder. The pressure gauge should reflect adequate gas volume for the anticipated case duration, and the cylinder must be firmly secured. A filtered insufflation line is connected to the insufflator, primed to expel ambient air, and attached securely to the trocar. Initial flow is set at 1–2 L/min until entry is confirmed, after which pressure is increased gradually to the surgeon’s target, usually 10–15 mmHg. Intra-abdominal pressure requires continuous observation. A sudden increase beyond 20 mmHg may reflect a kinked or obstructed line, while failure to maintain pressure often points to a leak at the trocar site or filter junction.

Troubleshooting proceeds systematically from the trocar backward to the insufflator, tightening each connection and verifying patency along the way. Smoke evacuation is activated whenever electrocautery or advanced energy devices are in use. Evacuation tubing is connected to a port near the operative field, with filters checked for expiry and replaced as necessary. Flow must be balanced carefully—strong enough to clear smoke effectively but not so forceful as to collapse the pneumoperitoneum. Placement of the insufflation and evacuation lines on opposite sides of the abdomen helps maintain this equilibrium. When visibility deteriorates, the sequence for troubleshooting is deliberate. The lens is inspected first for fogging, then the light intensity verified. If image darkening persists, the adequacy of insufflation is checked, as a partially collapsed abdomen reduces working space and visibility. Only after these steps are confirmed should trocar seals and tubing be evaluated for leaks.

Disposable devices are tracked carefully during each procedure. Lot numbers and Unique Device Identifiers (UDIs) are recorded in the intraoperative documentation before disposal, and packaging is kept until records are complete. Implant labels or barcodes are affixed into the patient record immediately upon use to ensure traceability.

At the conclusion of the case, instrument sets are opened and inspected for missing tips, screws, or insulation damage. Instruments are placed into trays with silicone mats to protect working ends, with heavier instruments arranged at the bottom to avoid crushing more delicate items. Rigid scopes are secured in padded holders, reducing the risk of damage during transport.

Point-of-use cleaning begins before instruments leave the OR. Gross contamination is wiped away with damp sterile gauze, lumens are flushed with sterile water, and surfaces are kept moist until cleaning. This prevents desiccation of biological material, which can make effective sterilization more difficult. Instruments are then transferred in covered, labeled containers to the decontamination area.

Final documentation includes confirmation of counts, implant tracking, and notation of any equipment malfunction. Defective devices are immediately removed from circulation, tagged, and reported to sterile processing staff. Prompt communication prevents repeat use of compromised equipment in future procedures.

Self-Assessment

Please complete the following: Quiz 2: Laparoscopy Setup - ECSACONM

Cumulative Test

Please complete the following: Module Test: Laparoscopy Setup - ECSACONM

Developer Instructions

In a brief paragraph or two, describe your simulator. What does it look like? What does it do? What are the layers or elements? Work on this section after completing Simulation requirements

• Simulator Build Instructions - to be created after completing Simulator Build specifications
• Simulator Practice Instructions - to be created after completing Simulator Build specifications

• Link: [Description]
• Link: [Description]

• Link
• Link

Developer Instructions

Include any research or sources you used to develop this module that may be helpful to learners. You may also add evidence demonstrating the module’s impact or effectiveness.

|

Developer Instructions

Include any research or sources you used to develop this module that may be helpful to learners. You may also add evidence demonstrating the module’s impact or effectiveness.

|

Developer Instructions

Include any research or sources you used to develop this module that may be helpful to learners. You may also add evidence demonstrating the module’s impact or effectiveness.

• Link: [Description]

• Link: [Description]