Chapter 13 - Minimally Invasive Surgical Techniques Flashcards
What is a primary advantage of minimally invasive surgical techniques in equine patients?
A) Increased incision size B) Decreased postoperative pain and morbidity C) Longer recovery times D) Increased surgical site infection rates
B) Decreased postoperative pain and morbidity
Which minimally invasive surgery is most commonly performed among large-animal surgeons?
A) Laparoscopy B) Arthroscopy C) Thoracoscopy D) Endoscopic upper airway surgery
B) Arthroscopy
What is a disadvantage of minimally invasive surgery mentioned in the text?
A) Increased visibility B) Specialized equipment costs C) Reduced recovery times D) Decreased soft tissue trauma
B) Specialized equipment costs
Which procedure has become the standard of care for articular procedures in equines?
A) Open surgery B) Laparoscopy C) Arthroscopy D) Thoracotomy
C) Arthroscopy
What technique is used for accessing the dorsal abdomen in mares?
A) Open laparotomy B) Laparoscopy C) Thoracoscopy D) Endoscopy
B) Laparoscopy
What surgical method has replaced laryngotomy in respiratory surgery when available?
A) Open surgical approach B) Diode laser ventriculocordectomy C) Laparoscopic surgery D) Standard endoscopic techniques
B) Diode laser ventriculocordectomy
What is a challenge of implementing robotic surgical platforms in equine surgery?
A) Increased surgical precision B) High cost and equipment adaptation C) Enhanced visibility D) Reduced surgical site infections
B) High cost and equipment adaptation
Which of the following is NOT a type of minimally invasive surgery mentioned for equine patients?
A) Thoracoscopy B) Natural orifice transluminal endoscopic surgery (NOTES) C) Single-incision laparoscopic surgery (SILS) D) Open abdominal surgery
D) Open abdominal surgery
What is the primary purpose of a light source in an endoscopy tower?
A) Provide heat to tissues B) Illuminate the surgical field C) Reduce costs D) Cool the surgical instruments
B) Illuminate the surgical field
Which light source is considered optimal for illumination in equine surgeries?
A) 100-W LED B) 150-W halogen C) 300-W Xenon D) 400-W fluorescent
C) 300-W Xenon
What is a significant benefit of using LED light sources over Xenon sources?
A) Shorter operational life B) More expensive replacements C) Longer lifespan and lower maintenance costs D) Higher heat generation
C) Longer lifespan and lower maintenance costs
In a three-chip video camera, what is the benefit of using three separate CCDs?
A) Lower cost B) Enhanced image quality C) Smaller size D) Increased weight
B) Enhanced image quality
What type of sterilization is most suitable for video cameras used in surgeries?
A) Autoclaving only B) Ethylene oxide or plasma C) Chemical sterilization only D) Radiation
B) Ethylene oxide or plasma
What is the recommended intraarticular pressure for arthroscopy?
A) Up to 50 mm Hg B) Up to 100 mm Hg C) Up to 150 mm Hg D) Up to 200 mm Hg
C) Up to 150 mm Hg
What is the primary gas used for insufflation during laparoscopic procedures?
A) Helium B) Nitrous oxide C) Carbon dioxide (CO2) D) Oxygen
C) Carbon dioxide (CO2)
How does insufflation with CO2 affect the abdominal cavity postoperatively?
A) Decreases white blood cell count B) Causes a mild inflammatory reaction C) Has no effect D) Enhances healing
B) Causes a mild inflammatory reaction
Which pressure is typically adequate for thoracoscopy?
A) 1 mm Hg B) 5 mm Hg C) 10 mm Hg D) 15 mm Hg
B) 5 mm Hg
Which pressure is typically adequate for arthroscopy?
A) 1 mm Hg B) 5 mm Hg C) 15 mm Hg D) 150 mm Hg
D) 150 mm Hg
Which pressure is typically adequate for laparoscopy?
A) 1 mm Hg B) 5 mm Hg C) 15 mm Hg D) 150 mm Hg
C) 15 mm Hg
What is the flow rate recommended for arthroscopu?
A) 1.5 L/min B) 2.5 L/min C) 3.5 L/min D) 4.5 L/min
A) 1.5 L/min
What is a potential cardiopulmonary effect of increased intraabdominal pressure during laparoscopic procedures?
A) Enhanced ventilation B) Decreased cardiac return C) Improved oxygenation D) Stabilized heart rate
B) Decreased cardiac return
What is a primary consideration when positioning the endoscopy tower during laparoscopic procedures?
A) Aesthetics B) Surgeon comfort and visibility C) Equipment weight D) Patient size
B) Surgeon comfort and visibility
What is the function of the fluid irrigation system in arthroscopy?
A) To provide thermal regulation B) To maintain intraarticular pressure and visualization C) To cool the surgical instruments D) To enhance blood flow
B) To maintain intraarticular pressure and visualization
What is the disadvantage of using a sterile sleeve for the video camera?
A) It is cost-prohibitive. B) It can cause fog formation due to fluid entry. C) It is difficult to apply. D) It is not sterilizable.
B) It can cause fog formation due to fluid entry.
Which type of system allows adjustment of flow rate based on intra-abdominal pressure during surgery?
A) Standard IV drip B) Gravity flow system C) Motorized roller pump D) Manual pump
C) Motorized roller pump
In equine laparoscopy, what pressure settings are typically required?
A) Up to 5 mm Hg B) Up to 10 mm Hg C) Up to 15 mm Hg D) Up to 20 mm Hg
C) Up to 15 mm Hg
What is a common reason for the slower evolution of thoracoscopic techniques compared to other methods?
A) Increased costs B) Rare surgical diseases affecting the equine thorax C) Technical challenges D) Lack of trained personnel
B) Rare surgical diseases affecting the equine thorax
What is a significant drawback of using single-incision laparoscopic surgery (SILS) in equines?
A) Improved cosmetic outcomes B) Reduced tactile feedback and triangulation C) Increased patient comfort D) Lower surgical costs
B) Reduced tactile feedback and triangulation
What technological advancement has been introduced to enhance dexterity in minimally invasive surgery?
A) 3D imaging systems B) Robotic surgical platforms C) Fiber optic cables D) Standard laparoscopic instruments
B) Robotic surgical platforms
What is the main purpose of using a fluid irrigation system during arthroscopy?
A) Maintain intraarticular pressure B) Increase tissue temperature C) Provide anesthesia D) Enhance visibility
A) Maintain intraarticular pressure
Which of the following procedures is NOT typically performed via laparoscopy?
A) Ovariectomy in mares B) Cryptorchidectomy C) Inguinal herniorrhaphy D) Open heart surgery
D) Open heart surgery
What is the ideal video resolution for enhanced imaging in surgical settings?
A) 640 × 480 pixels B) 1280 × 720 pixels C) 1920 × 1080 pixels D) 3840 × 2160 pixels
C) 1920 × 1080 pixels
What is a primary role of the insufflator during laparoscopic surgery?
A) Deliver anesthetic B) Maintain intraabdominal pressure C) Cool the surgical area D) Enhance blood flow
B) Maintain intraabdominal pressure
Which camera technology provides superior image quality for surgical procedures?
A) Single-chip cameras B) Three-chip cameras C) Analog cameras D) Standard definition cameras
B) Three-chip cameras
What is one benefit of using motorized roller pumps for fluid irrigation?
A) Manual operation B) Automatic flow rate adjustment C) Lower costs D) Increased fluid waste
B) Automatic flow rate adjustment
What challenge does the limited amplitude of laparoscopic instruments pose?
A) Improved visibility B) Reduced dexterity C) Enhanced patient comfort D) Increased surgical site infection
B) Reduced dexterity
Why is a powerful light source particularly important in equine abdominal or thoracic surgeries?
A) To minimize costs B) To ensure good visualization in larger cavities C) To reduce the number of instruments needed D) To avoid the use of anesthesia
B) To ensure good visualization in larger cavities
What advantage does NOTES offer in minimally invasive surgery?
A) Increased incision size B) Reduced recovery times C) Access through natural orifices D) Elimination of all surgical instruments
C) Access through natural orifices
Figure 13-8. Set of cutting instruments for arthroscopy/tenoscopy. Top to bottom: hooked knife, banana knife, one straight single-sided cutting knife, and two angled single-sided cutting knives.
Figure 13-9. The suction arthroscopic punch rongeurs is a sturdy and sharp instrument that allows débridement of dense soft tissues and instant removal of debris. (Reprinted with permission from Sontec Instruments, Inc., Centennial, Colorado, 2010.)
Figure 13-10. Handpiece of a motorized shaver with disposable blades. The control knobs allow a forward, backward, or oscillating mode, but foot switch control is also possible. (A) Tooth-edged synovial resector. (B) Burr for bone débridement (Acromionizer, Dyonics). (© Smith & Nephew, Inc.)
What is the optimal angle range for triangulation in endoscopic surgery?
A) 10–20 degrees B) 15–25 degrees C) 25–45 degrees D) 30–60 degrees
C) 25–45 degrees
What problem arises when the triangulation angle falls below 20 degrees?
A) Improved visibility B) Loss of optical-coaxial alignment C) Clashing of instruments D) Enhanced maneuverability
C) Clashing of instruments
In minimally invasive surgery, what is the “sword fighting effect”?
A) Improved instrument navigation B) Difficult instrument maneuvers due to loss of triangulation C) Enhanced field visualization D) Decreased surgical time
B) Difficult instrument maneuvers due to loss of triangulation
Which technique was developed to overcome challenges in triangulation?
A) Single-incision laparoscopic surgery B) Robotic-assisted surgery C) Wristed instruments D) Open surgical techniques
C) Wristed instruments
What is the “reverse-camera effect” in endoscopic surgery?
A) Enhanced depth perception B) An inverted image displayed on the monitor C) Improved triangulation D) Increased surgical efficiency
B) An inverted image displayed on the monitor
Which simulator is mentioned as an effective training tool for laparoscopic skills?
A) Avid Trainer B) MISTELS C) Virtual Reality Simulator D) Surgical Navigation System
B) MISTELS
What is the outer diameter of the most commonly used arthroscope in veterinary arthroscopy?
A) 3 mm B) 4 mm C) 5 mm D) 6 mm
B) 4 mm
What is the purpose of the conical obturator during arthroscopic procedures?
A) To inflate the joint capsule B) To protect the arthroscope during insertion C) To assist in visualization D) To provide irrigation
B) To protect the arthroscope during insertion
What is the primary use of a blunt hooked probe in arthroscopy?
A) Cutting soft tissue B) Evaluating cartilage and manipulating structures C) Removing bone fragments D) Irrigating the joint
Which instrument is preferred for detaching bony fragments during arthroscopy?
A) Blunt probe B) Elevator C) Curette D) Rongeur
B) Elevator
What feature is important for Ferris-Smith rongeurs used in equine arthroscopy?
A) Lightweight design B) Multiple jaw angles C) Disposable construction D) Electric operation
B) Multiple jaw angles
Why is a bone awl used in arthroscopic procedures?
A) To remove soft tissue B) To create microfractures in subchondral bone C) To visualize the joint D) To stabilize the joint
B) To create microfractures in subchondral bone
What is a disadvantage of using sharp obturators for joint access?
A) Increased fluid loss B) Difficulty in maneuvering C) Risk of iatrogenic damage to intrasynovial structures D) Higher costs
C) Risk of iatrogenic damage to intrasynovial structures
Which of the following instruments is NOT typically used in arthroscopy?
A) Curette B) Electrocautery C) Ferris-Smith rongeurs D) Bone awl
B) Electrocautery
What is the function of the egress cannula in arthroscopic procedures?
A) To deliver anesthetic B) To flush the joint C) To visualize the joint D) To stabilize the instruments
B) To flush the joint
Which instrument is particularly useful for retrieving loose fragments from the suprapatellar pouch?
A) Curette B) Ferris-Smith rongeurs C) Bone awl D) Elevator
B) Ferris-Smith rongeurs
What is the preferred design for the blade of a beaver blade used in arthroscopy?
A) Fixed and non-removable B) Disposable and consistently sharp C) Heavy and cumbersome D) Short and blunt
B) Disposable and consistently sharp
What is the purpose of using angled curettes in arthroscopy?
A) To provide better traction B) To access less reachable areas C) To remove larger bone fragments D) To stabilize the joint
B) To access less reachable areas
Which type of rongeur is commonly used for trimming lesions during arthroscopic procedures?
A) Large jaw rongeurs B) Ferris-Smith rongeurs C) Biopsy rongeurs D) Scissors
B) Ferris-Smith rongeurs
What is the most significant risk associated with using sharp instruments in arthroscopy?
A) Breakage of instruments B) Iatrogenic injury to tissue C) Increased operative time D) Infection
B) Iatrogenic injury to tissue
In terms of arthroscopy, what does the term “triangulation” specifically refer to?
A) The alignment of surgical lights B) The angles formed by the instruments and the target C) The placement of the patient on the surgical table D) The use of multiple camera angles
B) The angles formed by the instruments and the target
What is the ideal angle of the lens on a standard arthroscope used in equine surgery?
A) 10 degrees B) 25 to 30 degrees C) 35 degrees D) 45 degrees
B) 25 to 30 degrees
How is the arthroscope protected during insertion into the joint?
A) By using a rigid sheath B) By lubricating it with saline C) By wrapping it in gauze D) By placing it in a sterile bag
A) By using a rigid sheath
What is the importance of optical-coaxial alignment during endoscopic surgery?
A) It minimizes the number of instruments needed B) It enhances visibility and maneuverability C) It ensures all components are in a straight line for visualization D) It reduces surgical time
C) It ensures all components are in a straight line for visualization
Which of the following best describes the use of wristed instruments in laparoscopic surgery?
A) They increase the size of the incisions. B) They allow for greater dexterity in tight spaces. C) They eliminate the need for triangulation. D) They simplify the surgical procedure.
B) They allow for greater dexterity in tight spaces.
What is the role of stopcocks in the arthroscopic sleeve?
A) To regulate light exposure B) To control fluid ingress and egress C) To stabilize the camera position D) To facilitate instrument movement
B) To control fluid ingress and egress
What type of tissue should be avoided in the reverse-camera effect scenario?
A) Bony structures B) Cartilage C) Soft tissue D) Synovial fluid
C) Soft tissue
What is the purpose of using a thin osteotome during arthroscopy?
A) To create large incisions B) To manipulate cartilage C) To fracture large bone fragments D) To suction fluid
C) To fracture large bone fragments
How does a rounded elevator facilitate fragment detachment?
A) By providing a lever mechanism B) By increasing the incision size C) By minimizing tissue trauma D) By reducing the number of instruments needed
A) By providing a lever mechanism
Which of the following statements about arthroscopy is true?
A) It is exclusively for equine surgeries. B) It requires large incisions for access. C) It is the standard procedure for exploring joint disorders. D) It cannot be used in human medicine.
C) It is the standard procedure for exploring joint disorders.
What is a common characteristic of instruments used in arthroscopy compared to human medicine?
A) They are typically heavier and larger. B) They are made from disposable materials. C) They often have finer tips. D) They are more fragile.
A) They are typically heavier and larger.
Why is it essential to maintain true vertical and horizontal axes with the camera during surgery?
A) To improve aesthetic outcomes B) To ensure accurate visualization of the target C) To reduce instrument fatigue D) To increase surgical speed
B) To ensure accurate visualization of the target
What is a potential disadvantage of using a monocular view in arthroscopic simulators?
A) Reduced depth perception B) Increased training time C) Higher costs D) Lower quality images
A) Reduced depth perception
What type of lavage cannula is preferred for flushing large debris from joints?
A) Small-diameter with side holes B) Large-diameter without side holes C) Standard-length with multiple openings D) Short and flexible
B) Large-diameter without side holes
What is the primary advantage of using a disposable blade in arthroscopic procedures?
A) Cost-effectiveness B) Consistent sharpness C) Eco-friendliness D) Ease of use
B) Consistent sharpness
What surgical technique is similar in principle to arthroscopy but applied to tendon sheaths?
A) Bursoscopy B) Tenoscopy C) Laparoscopy D) Endoscopy
B) Tenoscopy
What is the recommended working length for most arthroscopes?
A) 100–120 mm B) 140–160 mm C) 160–175 mm D) 200–220 mm
C) 160–175 mm
How does the introduction of wristed instruments enhance the surgical procedure?
A) They eliminate the need for triangulation. B) They provide a greater range of motion. C) They reduce instrument clashing. D) They minimize patient discomfort.
B) They provide a greater range of motion.
Which instrument is typically used for débridement of subchondral bone?
A) Elevator B) Curette C) Rongeur D) Bone awl
B) Curette
What is the significance of having different sizes and shapes of arthroscopic instruments?
A) To increase the cost of surgery B) To allow for tailored approaches to various anatomical challenges C) To standardize all surgical procedures D) To minimize the variety of instruments in the surgical field
B) To allow for tailored approaches to various anatomical challenges
What is the typical power output setting range for monopolar electrosurgery?
A) 20-30 W B) 40-90 W C) 60-100 W D) 80-120 W
B) 40-90 W
At what temperature does cell vaporization occur?
A) 40°C B) 50°C C) 100°C D) 150°C
C) 100°C
What percentage of synovial sepsis risk is typically associated with elective arthroscopy?
A) 0.1%–0.5% B) 0.5%–1% C) 1%–2% D) 2%–5%
B) 0.5%–1%
What is the recommended distention pressure for the synovial cavity during arthroscopy?
A) 30-60 mm Hg B) 60-150 mm Hg C) 100-200 mm Hg D) 150-250 mm Hg
B) 60-150 mm Hg
How long can equine synovial villi take to regenerate after synovectomy?
A) 1 month B) 3 months C) 6 months D) 12 months
C) 6 months
What is the diameter of the most commonly used cannula in equine laparoscopy/thoracoscopy?
A) 5 mm B) 8 mm C) 10 mm D) 11 mm
D) 11 mm
What percentage of patients is likely to experience a higher risk of infection during carpal sheath tenoscopies?
A) 1%–2% B) 2%–3% C) Higher than 1% D) No significant risk
C) Higher than 1%
What is the maximum working length for standard human laparoscopes?
A) 20 cm B) 30 cm C) 40 cm D) 57 cm
B) 30 cm
Which temperature range results in cell death during electrosurgery?
A) 30°C–40°C B) 40°C–50°C C) 50°C–60°C D) 60°C–70°C
B) 40°C–50°C
What is the length of the specialized laparoscope available for equine surgery?
A) 30 cm B) 40 cm C) 57 cm D) 60 cm
C) 57 cm
What is the common outcome when using 1.5% glycine solution in electrosurgery studies?
A) Increased infection rate B) No significant impact on results C) Decreased efficiency D) Increased power settings
B) No significant impact on results
What is the typical outer diameter of endoscopes used in equine laparoscopy?
A) 8 mm B) 10 mm C) 11 mm D) 12 mm
B) 10 mm
What is the effect of using saline solutions in the synovial cavity during surgery?
A) Permanent damage to cartilage B) Temporary inhibition of proteoglycan synthesis C) Enhanced visibility D) Increased healing time
B) Temporary inhibition of proteoglycan synthesis
How many categories are motorized blades divided into?
A) One B) Two C) Three D) Four
C) Three
What is the benefit of using a Teflon-coated probe in electrosurgery?
A) Higher voltage B) Reduced electrical dispersion C) Increased thermal damage D) Increased tissue heating
B) Reduced electrical dispersion
What is the typical skin incision size for arthroscopy?
A) 5-10 mm B) 10-15 mm C) 15-20 mm D) 20-25 mm
B) 10-15 mm
What is the diameter of the optical trocar used in some procedures?
A) 10 mm B) 11 mm C) 12 mm D) 13 mm
C) 12 mm
How long does a typical surgery under general anesthesia take compared to standing procedures?
A) 10% longer B) 25% longer C) 50% longer D) Significantly longer
B) 25% longer
What is the power setting for radiofrequency chondroplasty that can cause significant thermal damage?
A) Less than 10 W B) 10-20 W C) Greater than 20 W D) 30-40 W
C) Greater than 20 W
Figure 13-13. (A) Laparoscopic cannula. (B) 5-mm reducer cap.
(C) Reusable safety trocar.
Figure 13-14. Visiport optical trocar. (A) Close-up view of the transparent lens at the end of the trocar. (B) Insertion technique of the Visiport trocar by introduction of the laparoscope in the handle. (Image courtesy Louis-Marie Desmaizieres.)
Figure 13-15. Basic laparoscopic instrument set. (A) Semm claw forceps. (B) Knot pusher. (C) Babcock forceps. (D) Injection needle. (E) Needle holders. (F) Scissors.
Figure 13-16. Laparoscopic Babcock forceps used as a knot pusher.
Figure 13-17. LigaSure vessel-sealing device. (A) LigaSure handpiece. (B) Close-up view of the instrument tip. (C) Laparoscopic view of the LigaSure being applied to the spermatic cord of an abdominal cryptorchid for hemostasis and transection.
Figure 13-18. Close-up view of a 4-S modified Roeder slipknot.
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Figure 13-23. Fogarty catheter in closed (top) and expanded (bottom) positions.
Figure 13-24. (A) A plate-passing device made from a broad DCP with a sharpened end and handle to facilitate formation of a subcutaneous tunnel.
(B) The plate-passing device being contoured using a large plate-bending device. (C) The plate-passing device being introduced through a proximal incision. The device is used to create a subcutaneous tunnel on the dorsolateral surface of the third metatarsal bone.
Figure 13-26. Equipment used for navigation. (A) Arcadis Orbic 3D C-arm. (B) The corresponding computer with monitor. (C) The VetGATE computer system with monitor (ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland). (D) The two-eyed navigation camera (Polaris Spectra) on which the preoperative planning is performed and subsequent surgical guidance is viewed.
