Cold light sources are important for laparoscopy but are currently available sources actually cold light source? What is the effect of cold light on the problem of fogging apart from the chances of visceral injury?
Within ones own trust, we use the striker, tantara and stortz fibre optic light leads. All three will generate heat at the contact end or when connected/in use the end of laprascope. Only way to control this is by ensuring the light is on standby when not in use and when placing the laprascope or light lead on the operating field.
The temperature measurements at the tip of the scopes varied between 60 degrees C and 100 degrees C (Celsius). Direct contact of the tip of the fiber optic cable caused total carbonization in the wall of the small bowel. Therefore, we do not recommend direct contact of scopes with the intra-abdominal organs to avoid heat injuries.
Cold light means that the proportion of blue, green and red are approximately equal, and are produced by a source around 7000 Kelvin degrees. Domestic light has an increased proportion of red (warm) light and is produced by a source around 3000 Kelvin degrees. Cold light does not mean that its temperature is lower. If you will touch the bulb you will have a burning.
The future is near . LED produce less heat., Chemiluminescene devices (Cold light) are short in duration and the amount of light is limited. The chemicals current in use are toxic if the capsules break , thus it is my opinion that these devices should be investigated for future use in Peritoneoscopy.
Secured independent tools in peritoneoscopy.
Tsin DA, Davila F, Dominguez G, Manolas P.
JSLS. 2010 Apr-Jun;14(2):256-258
PMID: 20932379
Transabdominal wall deployment for instruments, lights, and micromotors using the concept of secured independent tools.
Tsin DA, Davila F, Dominguez G, Tinelli A, Davila MR.
J Laparoendosc Adv Surg Tech A. 2012 May;22(4):397-9.
PMID: 22393923
All laparoscopic light sources at present produce heat. They can cause burning at full power when not in standby mode.
In the future LED light sources should produce less heat, and should be 'cooler' than the current light sources.
Fogging occurs when the warmer, highed humidity, intracavity (intraabdominal) CO2 contacts a colder laparoscope. Currently there are available humidification and warming (39-40 deg celsius) devices that are connected in series with the insufflation device, that reduces fogging a great deal.
I would imagine a colder light source would need a warming and humidification device in the system.
Even though LED Light source produces less heat, it can still cause burns injury. Therefore, the light source should be put at standby when not in use and the tip of the fibre-optic cable or illuminated laparoscope should be put away from the skin. I think the practice of cleaning the laparoscope by rubbing it on the bowel should also be discouraged.
Dr. Adebayo Adewole
Consultant Ob/Gyn and Minimal Access Surgeon.