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Surgery > Basic laparoscopic surgery (Case) > Flashcards

Basic laparoscopic surgery (Case) Flashcards

1
Q

MIS

A
  • any sx that is less invasive or results in less tissue trauma compared to open surgery
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2
Q

Endoscopy

A
  • Performed with a telescope and a camera
  • video displayed on screen
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3
Q

Laparoscopy/thoracoscopy

A

endoscopy in the abdomen/endoscopy in the thorax

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4
Q

OVE/OHE

Peritoneal access

A
  • Veress needle (fills with gas)
  • modified Hasson
  • Mini-laparotomy
    • SILS
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5
Q

Threaded cannula

A
  • screw in
  • rubber reducer valves
    • insufflation
    • no insufflation
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6
Q

The tower

A
  • light source
    • 200-300 watts now
  • video control unit
  • insufflator
    • CO2 gas always and only
    • controls flow rate and max pressure
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7
Q

Bipolar cautery

A
  • Basic RF units
  • Ligasure
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8
Q

Forceps

A
  • Babcock
  • Scissor
  • Kelly
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9
Q

Endo-staplers

A
  • EndoGIA
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10
Q

Gas sterilization

A
  • ethylene oxide or gas plasma
  • preferred for scopes, cameras, & cables
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11
Q

Steam sterilization

A
  • Gravity dependent
  • OK for scopes, cameras, cables
  • reduced life
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12
Q

Cold sterilization

A
  • 2% glutaraldehyde
  • sterilize scopes between procedures
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13
Q

Indications for laparoscopy

A
  • Elective procedures
    • ovariectomy, gastropexy, cryptorchidectomy, biopsy
  • client requests
    • preceived benefits (cholecystectomy)
  • patient morbidity
    • less pain, hospitalization, medication, infection, cost to owner?
  • Hospital reputation
    • competition: quality and image of practice
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14
Q

Contraindications for laparoscopy

A
  • surgeon
    • inexperience or lack of comfort
    • must have developed psychomotor skills
  • staff (anesthesiologist, technician)
    • inexperience or lack of comfort
  • lack of instrumentation
    • cannulas, graspers, endoscopes, BIPOLAR
  • advanced and exploratory procedures?
    • GI, cholecystectomy, adrenalectomy, splenectomy
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15
Q

Physiologic effect abdominal insufflation

A
  • pressure against diaphragm and vena cava
  • dec thoracic compliance and venous return
  • dec tidal volume and cardiac output
  • outcome
    • hypoventilation
    • hypoxemia
    • acidemia
  • Solution
    • PPV
    • limit IAP and duration
      • dogs: < 12mmHg
      • cats: < 8mmHg
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16
Q

Sources of pain

A
  • Incisions
  • Peritoneal CO2
  • Stretching of diaphragm
17
Q

Incisions

A
  • Source of pain
    • cutaneous and muscular nerve endings
    • nociceptors
  • concl
    • limit incision size and number
    • local blocks
    • NSAIDS
18
Q

Peritoneal CO2

A
  • sources of pain
    • chemical irritation of peritoneum
    • Nonhumidified gas
      • desiccation of peritoneum
  • concl
    • evacuate residual gas
    • use humidified gas
19
Q

Stretching of diaphragm

A
  • Sources of pain
    • Neuropraxia
      • phrenic nerves
      • visceral afferents
  • concl
    • limit insufflation pressure
      • dogs < 12 mmHg
      • cats < 8mmHg
    • limit duration of surgery
20
Q

AVMA consensus

Ovariectomy or Ovariohysterectomy

A
  • yes we should neuter
    • doesn’t favor OHE over OVE
  • pormotes gonadectomy as primary welfare issue for Americans
21
Q

Preparation

Lap OVE

A
  • Wide abdominal clip
  • Sterile preparation
  • Wide draping
    • 2-port method
    • SPAGO
22
Q

LAP OVE

Peritoneal access

A
  • veress needle
  • modified Hasson
  • Mini-laparotomy
    • SILS
23
Q

LAP OVE

Local analgesia

A
  • Bupivicaine block
    • 1 mg/kg
  • prior to port placement
24
Q

Ports for OVE

A
  • Camera: 1 cm caudal to umbilicus
  • Instruments: 2-4 cm crania to umbilicus
25
Q

Ports for OHE

A
  • Camera: 1 cm caudal to umbililcus
  • Instruments
    • a. 2-4 cm cranial to umbilicus
    • b. 1/3 distance umbilicus to pubis
26
Q

Ligasure

A
  • bipolar electorsurgery
  • compresses and denatures
  • creates tissue seal
    • > 7mm vessels
    • 3X systolic pressure
27
Q

LAP OVE

Closure of port incisions

A
  • 5 mm: subcutaneous and skin
  • 10 mm and up
    • linea, subcutaneous
    • skin
    • interrupted or cruciate to hold in body wall, prevent herniation
28
Q

LAP OVE

Complications

A
  • Splenic laceration/ hemorrhage
  • Pedicle hemorrhage
  • Subcutanous emphysema
  • Loss of insufflation: slipped cannula
  • Dropped ovary or pedicle
  • Conversion is NOT a complication
29
Q

Prophylactic gastropexy indications

A
  • at risk dogs
    • relative with GDV
    • large breed & deep chest
    • Danes (40% lifetime risk)
    • Irish wolfhound
    • stadard poodle
30
Q

LAP gastropexy

Complications

A
  • Seroma - very common
  • Splenic laceration/hemorrhage
  • serosal tearing
  • loss of insufflation
    • enlarged incision
  • dropped stomach
  • conversion to keyhole technique possible
31
Q

Summary MIS

A
  • Less pain, tissue trauma, analgesics, infection
  • More precision, safety, inc reputation of a clinic
  • unique instrumentation required
  • unique physiologic consequences
  • start with elective procedures
  • conversion isn’t a complication
32
Q

Surgical complications OVH or OVE

A
  • Postoperative hemorrhage
    • ovarian a.
    • uterine a.
    • broad ligament
  • Ureteral ligation?
    • ovarian pedicles (11%)
    • uterine bodies (17%)
  • Ovarian remnant syndrome (ORS)
    • incision location
    • right pedicle 70%
33
Q

Long-term complications

OVH or OVE

A
  • Uterine neoplasia
    • 1/3000, 85% leiomyoma
    • 1/30,000 risk malignant
    • uterine stump leiomyosarcoma just as likely
  • Endometritis/Pyometra
    • 15-25% risk by 10 years
    • Requires functional ovarian tissue
    • Disease of luteal phase (diestrus)
34
Q

OVH or OVE for dogs and cats

A
  • Evidence supports OVE over OVH
    • easier
    • fewer complications
    • less tissue trauma
    • less painful
    • faster
    • minimally invasive
  • discretion of practitioner, either is acceptable

Surgery (11 decks)

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