The variety of manipulative instruments used in laparoscopic surgery is increasing all the time. Retraction can be achieved using a wide range of tissue-holding forceps (Table 4.1), dissectors, probes and dedicated retractors (Table 4.2). These instruments are available in various sizes, shapes and forms to suit different purposes.

Grasping forceps tip can be single action or double action, atraumatic or traumatic, straight, curved, Allis, Babcock or angled (Table 4.1) and can have a locking or non-locking handle. Retraction during laparoscopy is done by applying grasping forceps, but in special circumstances, laparoscopic retractors are required. Scissors are usually used for dissection with or without diathermy. Scissors tip can be fine, curved, straight or hooked (Table 4.3). Suturing requires needle holders and at times knot drivers (Table 4.4).

The wider use of robotic surgery and LESS in Urology generated the need for new instruments (Table 4.5). New designs attempt to compensate the loss of triangulation in single site surgery. Complex surgical maneuvers can be achieved using robotic instruments which, unlike the human wrist, have a 360° range of motion (Table 4.6). The ability for more accurate movements and potentially safer surgery is enhanced by the 3D (three dimensional) visual output and the collision avoidance technology, which prevents collision between the instruments as well as the instruments and the camera both in and out of the body (Fig. 4.9). Critics however, will point out the complete lack of haptic feedback in robotic surgery.