title: Comparative analysis of techniques to prevent laparoscopic fogging.
abstract: OBJECTIVE
  To evaluate the efficiency and efficacy of two common and commercially available methods to resolve lens fogging: a Fluid Warming System (O.R. Solutions, Chantilly, VA) and the Clearify Visualization System (Covidien, Mansfield, MA).
  
  
  METHODS
  We prospectively evaluated 40 patients undergoing laparoscopic renal procedures with the Fluid Warming System (first 20 cases) and then the Clearify Visualization System (second 20 cases). We utilized the standard Fluid Warming System per a 30-second modified protocol established in our laboratory. We used the Clearify according to manufacturer instructions. For each procedure we documented the etiology of each episode of visual obstruction, procedure type and surgery duration. We performed a cost analysis. For all cases we used the same insufflator, insufflation trocar location and trocar configuration.
  
  
  RESULTS
  All 40 patients completed the study protocol without incident. The mean fogging events per hour for the Fluid Warming System and Clearify Visualization System were 0.7 (0-2.52) and 1.4 (0-5.02), respectively (P = 0.045). Surgery duration and cost per procedure were similar for both systems.
  
  
  CONCLUSIONS
  The Fluid Warming System with modified technique was found to have less fogging events than the Clearify Visualization System, with no difference in operative time or cost.
authors.affiliation: a Department of Urology , University of California , Irvine , CA , USA.
authors.forename: Austin
authors.initials: A
authors.lastname: Drysch
authors.affiliation: a Department of Urology , University of California , Irvine , CA , USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Schmitt
authors.affiliation: a Department of Urology , University of California , Irvine , CA , USA.
authors.forename: Brittany
authors.initials: B
authors.lastname: Uribe
authors.affiliation: a Department of Urology , University of California , Irvine , CA , USA.
authors.forename: Renai
authors.initials: R
authors.lastname: Yoon
authors.affiliation: a Department of Urology , University of California , Irvine , CA , USA.
authors.forename: Zhamshid
authors.initials: Z
authors.lastname: Okhunov
authors.affiliation: a Department of Urology , University of California , Irvine , CA , USA.
authors.forename: Jaime
authors.initials: J
authors.lastname: Landman
mesh_terms: D004867:Equipment Design; D006801:Humans; D007668:Kidney / Q000601:surgery; D020706:Laparoscopes; D010535:Laparoscopy / Q000295:instrumentation* / Q000379:methods*; D011446:Prospective Studies; D013525:Surgical Instruments
keywords: Clearify visualization system; fluid warming system; lens fogging; visual obstruction