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 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
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 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
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 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
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
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
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
Which instrument is preferred for detaching bony fragments during arthroscopy?
A) Blunt probe B) Elevator C) Curette D) Rongeur
B) Elevator
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 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 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
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
Which instrument is typically used for débridement of subchondral bone?
A) Elevator B) Curette C) Rongeur D) Bone awl
B) Curette
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%
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 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
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.
