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All instrument packs for MIS should include traditional open surgical instruments for the securing of drapes and initial port entry. Additionally, it is wise to always be prepared to convert to an open procedure when warranted. To that end, a general surgery pack containing at least drapes large enough to cover the patient and operating table; sufficient towel clamps to secure the drapes to the patient; a #3 scalpel handle; a pair each of Brown‐Adson and DeBakey thumb forceps; several curved mosquito and either Crile or Kelly hemostatic forceps; Metzenbaum, Mayo, and suture scissors; needle holders; a saline bowl; and 4 × 4 x‐ray detectable gauzes are needed.

Figure 4.15 An example of a laparoscopic instrument pack in its tray for sterilization and storage.

Source: Photo courtesy of Dr. Philipp Mayhew.

A basic starting laparoscopic instrument pack for a beginning endoscopic surgeon using multiple‐port approach should include a 5‐mm, 0° telescope or a 10‐mm, 0° telescope; a light cable; insufflator tubing; an endoscopic video camera; a Veress needle (if desired entry technique); three 5‐mm cannulas with two sharp‐tipped trocars and one blunt‐tipped trocar; one to two 10‐mm cannulas with one sharp and one blunt trocar (to accommodate a 10‐mm telescope, instruments, or energy devices); two reducer caps; 10‐mm double‐action Babcock or Duval grasping forceps; a 5‐mm double‐ or single‐action Babcock forceps; two 5‐mm curved Kelly or Maryland grasping‐dissecting forceps; 5‐mm Metzenbaum dissecting scissors; 5‐mm cup biopsy forceps with or without spikes; 5‐mm punch biopsy forceps; a‐5 mm palpation probe; and an ovariectomy hook.

For more advanced surgeons, this basic pack may be expanded to include right‐angle dissecting forceps; additional graspers such as atraumatic tissue graspers, bullet‐nosed graspers, or bowel graspers; needle holders (straight or curved); additional suturing equipment such as a knot pusher or Suture Assistant; hook scissors; a suction and lavage device; a fan retractor; a 5‐mm, 30° telescope; bipolar electrosurgical instrumentation; mini‐laparoscopic telescopes and instrumentation; and single‐port access cannulas with either articulating or roticulating instruments.

Instruments may be equipped with insulation and a connection for a monopolar electrosurgical device at the surgeon's preference. If modular instruments are chosen, at least one ratcheted and one nonratcheted handle should be included. Trays designed specifically for sterilization and safe storage of delicate endoscopic instruments are available and highly recommended (Figure 4.15). Often, the camera, telescopes, light cable, and insufflation tubing are packaged separately from the rest of the instruments.