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
What is the common range of the voltage applied in bipolar electrosurgery?
A) 10-20 V B) 20-30 V C) 30-40 V D) Constant
D) Constant
What percentage of soft tissue dissections can successfully use monopolar electrosurgery?
A) 40%-50% B) 60%-70% C) 70%-80% D) 80%-90%
C) 70%-80%
How long should a typical trocar be in length for laparoscopic surgery?
A) 10 cm B) 20 cm C) 30 cm D) 40 cm
B) 20 cm
How many different sizes and shapes of probes are available for bipolar electrosurgical devices?
A) 1-2 sizes B) 3-5 sizes C) 5-10 sizes D) Numerous sizes
D) Numerous sizes
What temperature can lead to tissue vaporization?
A) 60°C B) 70°C C) 100°C D) 120°C
C) 100°C
What is the range of power settings generally recommended for electrosurgical probes?
A) 20-30 W B) 30-50 W C) 40-90 W D) 50-100 W
C) 40-90 W
What temperature range is achieved with bipolar electrosurgery?
A) 40°C to 50°C B) 50°C to 60°C C) 60°C to 70°C D) Above 100°C
A) 40°C to 50°C
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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What is the most common diameter of instruments used for equine laparoscopy/thoracoscopy?
A) 5 mm B) 10 mm C) 12 mm D) 15 mm
B) 10 mm
What is the standard working length for most laparoscopic instruments mentioned?
A) 30 cm B) 37.5 cm C) 45 cm D) 57 cm
C) 45 cm
What is the outer diameter of the EndoStitch instrument?
A) 5 mm B) 10 mm C) 12 mm D) 15 mm
B) 10 mm
How long is the working length of the EndoStitch instrument?
A) 30 cm B) 37.5 cm C) 45 cm D) 50 cm
B) 37.5 cm
How much time does it take for vessel-sealing devices to create a seal?
A) 1-2 seconds B) 2-4 seconds C) 5-10 seconds D) 10-15 seconds
B) 2-4 seconds
What percentage of normal systolic blood pressure can vessel seals withstand?
A) 100% B) 200% C) 300% D) 400%
C) 300%
What is the typical number of staples fired by common endostaplers?
A) 2-4 B) 4-6 C) 6-8 D) 8-10
B) 4-6
What is the diameter of the Endo Universal stapler used for titanium staples?
A) 5 mm B) 10 mm C) 12 mm D) 15 mm
C) 12 mm
What is the maximum working length of laparoscopic needle holders designed for right-handed surgeons?
A) 30 cm B) 35 cm C) 45 cm D) 50 cm
D) 50 cm
What is the outer diameter of the laparoscopic Kelly grasping forceps recommended for use with the nondominant hand?
A) 5 mm B) 10 mm C) 11 mm D) 12 mm
A) 5 mm
What type of forceps can serve as both a grasping and knot-pushing device?
A) Semm claw forceps B) Babcock forceps C) Biopsy forceps D) Needle holders
B) Babcock forceps
What is the recommended diameter for cannulas when using endostaplers?
A) 5 mm B) 10 mm C) 12 mm D) 15 mm
C) 12 mm
What is the maximum number of tacks that can be deployed by the Protack fixation device?
A) 20 B) 25 C) 30 D) 35
C) 30
What is the working length of laparoscopic instruments that are designed for delicate manipulation?
A) 30 cm B) 45 cm C) 60 cm D) 75 cm
B) 45 cm
What is the standard suture size for the barbed suture V-Loc mentioned?
A) USP 0 B) USP 1 C) USP 2 D) USP 3
A) USP 0
What is the maximum pressure that vessel seals can withstand compared to normal systolic blood pressure?
A) Twice B) Three times C) Four times D) Five times
B) Three times
What is the angle of the Endo Universal stapler when applying staples?
A) 15 degrees B) 30 degrees C) 45 degrees D) 60 degrees
B) 30 degrees
How many different types of staplers are used in equine laparoscopy?
A) One B) Two C) Three D) Four
B) Two
1) Tacking devices anchor a mesh or a peritoneal flap at a desired location.They can be used alone or in combination with intracorporeal sutures and/or glue.
2) Endostaplers used for achieving gastrointestinal anastomoses in human surgery are useful tools for hemostasis of a large pedicle; however, vessel-sealing devices have replaced them in the laparoscopic instrument set
What is the percentage of time saved using tacking devices compared to traditional suturing techniques?
A) 10% B) 20% C) 30% D) 40%
C) 30%
What is the key advantage of using barbed suture V-Loc?
A) Reduces tissue trauma B) Eliminates the need for knot tying C) Provides a strong anchoring force D) All of the above
D) All of the above
What is the typical outer diameter of flexible endoscopes used in equine procedures?
A) 5-7 mm B) 8-10 mm C) 11-12 mm D) 13-15 mm
B) 8-10 mm
How long should horses be fasted before laparoscopic surgery?
A) 12-24 hours B) 24-36 hours C) 36-48 hours D) 48-72 hours
B) 24-36 hours
What is the maximum length of time recommended for horses to be in the Trendelenburg position?
A) 5 minutes B) 10 minutes C) 15 minutes D) 20 minutes
A) 5 minutes
What is the diameter of the trocar used in transvaginal NOTES?
A) 25 mm B) 30 mm C) 33 mm D) 36 mm
C) 33 mm
What is the typical external diameter of endoscopic instruments used for lumbosacral epiduroscopy?
A) 3.0 mm B) 3.5 mm C) 3.8 mm D) 4.0 mm
C) 3.8 mm
What is the maximum working length of the flexible endoscope for cervical vertebral canal endoscopy?
A) 100 cm B) 110 cm C) 120 cm D) 130 cm
B) 110 cm
What is the size of the incision made for laparoscopic access?
A) 1 cm B) 1.5 cm C) 2 cm D) 2.5 cm
B) 1.5 cm
What is the recommended distance from the last rib to the tuber coxae for portal placement?
A) 10 cm B) 15 cm C) 20 cm D) 25 cm
B) 15 cm
What is the average diameter of the working channel in flexible endoscopes?
A) 1.5 mm B) 2.0 mm C) 2.5 mm D) 2.8 mm
D) 2.8 mm
What is the risk associated with morcellating devices?
A) Faster surgery B) Tissue trauma C) Neoplastic cell spread D) All of the above
C) Neoplastic cell spread
What is the recommended surgical position for complicated thoracoscopic procedures?
A) Standing B) Dorsal recumbency C) Lateral recumbency D) Ventral recumbency
B) Dorsal recumbency
How many layers are closed for skin incisions larger than 10 mm?
A) 1 layer B) 2 layers C) 3 layers D) 4 layers
B) 2 layers
What is the maximum diameter for instruments used in cervical vertebral canal endoscopy?
A) 4 mm B) 5 mm C) 6 mm D) 7 mm
B) 5 mm
What is the expected decrease in mean arterial pressure when using the Trendelenburg position?
A) 5% B) 10% C) 15% D) 20%
B) 10%
What is the risk of complications associated with standing laparoscopic surgeries?
A) Low B) Moderate C) High D) Variable
A) Low
What is the common portal placement location for laparoscopic procedures?
A) Above the umbilicus B) At the umbilicus C) Below the umbilicus D) None of the above
B) At the umbilicus
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.
What is the typical diameter of a Fogarty graft thrombectomy catheter when expanded?
A) 12 mm B) 16 mm C) 20 mm D) 32 mm
B) 16 mm
What is the length of the Fogarty graft thrombectomy catheter?
A) 40 cm B) 50 cm C) 100 cm D) 110 cm
B) 50 cm
What is the dose of heparin administered intraoperatively per kg of body weight?
A) 50 IU B) 100 IU C) 150 IU D) 200 IU
B) 100 IU
What percentage of horses treated with minimally invasive thrombectomy regained athletic activity?
A) 50% B) 53% C) 60% D) 65%
D) 65%
What percentage of horses experience postanesthetic myopathy after surgery?
A) 10% B) 20% C) 24% D) 30%
C) 24%
What is the thickness of the embolization material’s coils used in horses?
A) 0.5 mm B) 1 mm C) 2 mm D) 3 mm
A) 0.5 mm
What is the most common embolization material used in horses?
A) Stainless steel B) Titanium C) Dacron-coated coils D) Nitinol
C) Dacron-coated coils
What is the success rate of restoring blood supply via thrombectomy, as per recent studies?
A) 60% B) 75% C) 80% D) 90%
A) 60%
What is the common suturing material used to close the femoral artery?
A) USP 3-0 B) USP 4-0 C) USP 5-0 D) USP 6-0
B) USP 4-0
What is the typical follow-up duration for monitoring postoperative recovery?
A) 2 weeks B) 3 weeks C) 4 weeks D) 6 weeks
C) 4 weeks
What proportion of cases requires additional femoral artery thrombectomy distal to the incision?
A) 20% B) 30% C) 40% D) 50%
C) 40%
What is the usual incision length for stab incisions in MIPO procedures?
A) 2-3 cm B) 2-4 cm C) 3-5 cm D) 5-6 cm
B) 2-4 cm
What percentage of patients may benefit from minimally invasive approaches for complex fractures?
A) 30% B) 40% C) 50% D) 60%
B) 40%
What is the time frame for initiating light exercise post-surgery?
A) 1 week B) 2 weeks C) 3 weeks D) 4 weeks
B) 2 weeks
What is the typical expanded diameter of the balloon catheter used for thrombectomy?
A) 16 mm B) 20 mm C) 32 mm D) 40 mm
C) 32 mm
What is the approximate size of the incision for accessing the femoral artery in a thrombectomy?
A) 8 cm B) 10 cm C) 12 cm D) 15 cm
B) 10 cm
How many IU of low-molecular-weight heparin are administered?
A) 30 IU/kg B) 40 IU/kg C) 50 IU/kg D) 60 IU/kg
C) 50 IU/kg
What type of fractures is MIPO primarily well-suited for?
A) Long bone fractures B) Lateral and medial condylar fractures C) Comminuted fractures in foals D) Simple fractures
B) Lateral and medial condylar fractures
Which joints can be arthrodesed using a minimally invasive approach?
A) Proximal interphalangeal joint only B) Metacarpophalangeal joint only C) Both proximal interphalangeal and metacarpo-/metatarsophalangeal joints D) None of the above
C) Both proximal interphalangeal and metacarpo-/metatarsophalangeal joints
In which condition is minimally invasive arthrodesis particularly indicated?
A) Mild joint instability B) Severe osteoarthritis with significant loss of articular cartilage C) Intact articular cartilage D) Normal suspensory apparatus
B) Severe osteoarthritis with significant loss of articular cartilage
What is the diameter of the drill bit used for partial cartilage débridement?
A) 4.0 mm B) 5.0 mm C) 5.5 mm D) 6.0 mm
C) 5.5 mm
Which type of fracture is more feasible for minimally invasive approaches in foals?
A) Simple fractures B) Long bone fractures C) Comminuted metacarpal III fractures D) Condylar fractures
C) Comminuted metacarpal III fractures
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.
