# Quantitative assessment of the troCarWash™ system for automated laparoscopic camera cleaning

## TL;DR

A new automated system called troCarWash™ was tested to clean laparoscopic cameras during surgery, improving visibility and reducing manual interruptions.

## Contribution

The troCarWash™ system enables in vivo automated cleaning of laparoscopic cameras with minimal user interaction and no modifications to the scope.

## Key findings

- The troCarWash™ system significantly improved camera clarity as measured by both digital and subjective methods.
- All four surgeons observed consistent improvements in visualization after using the device.
- Digital and subjective clarity scores were significantly correlated.

## Abstract

Soilage of the surgical endoscope occurs frequently during minimally invasive surgery. The resultant impairment of visualization of the surgical field compromises patient safety, prolongs operative times, and frustrates surgeons. The standard practice for cleaning the surgical camera involves a disruption in the conduct of surgery by completely removing the endoscope from the field, manually cleaning its lens, treating it with a surfactant, and reinserting it into the patient; after which the surgeon resumes the procedure.

We developed an automated solution for in vivo endoscope cleaning in minimally invasive surgery- a port that detects the position of the endoscope in its distal lumen, and precisely and automatically delivers a pressurized mist of cleaning solution to the lens of the camera. No additions to the scope and minimal user interaction with the port are required. We tested the efficacy of this troCarWash™ device in a porcine model of laparoscopy. Four board-certified general surgeons were instructed to soil and then clean the laparoscope using the device. Representative pre- and post-clean images were exported from the surgical video and clarity was graded (1) digitally by a canny edge detection algorithm, and (2) subjectively by 3 blinded, unbiased observers using a semi-quantitative scale.

We observed statistically significant improvements in clarity by each method and for each surgeon, and we noted significant correlation between digital and subjective scores.

Based on these data, we conclude that the troCarWash™ effectively restored impaired visualization in a large animal model of laparoscopy.

The online version contains supplementary material available at 10.1007/s00464-024-10858-z.