Chapter 2: Endoscopic and Minimally Invasive Surgery

Question 1

Who should be included in planning the design of the minimally invasive surgical suite?
A. Chief of surgery
B. Chief of anesthesia
C. Committee composed of biomedical engineers
D. Hospital chief of staff
E. Multidisciplinary committee

Answer 1

E. Multidisciplinary committee

Question 2

Which of the following gases is most commonly used for insufflation during laparoscopy?
A.  Air
B.  Carbon dioxide
C.  Helium
D.  Nitrogen
E.  Nitrous oxide

Answer 2

B. Carbon dioxide

Question 3

Which of the following is a potential complication of gas insufflation during MIS?
A.  Cardiac arrhythmias
B.  Decreased urine output
C.  Hypercarbia
D.  Gas embolism
E.  All of the above

Answer 3

E. All of the above

Question 4

All the following are precautions that should be taken with the gas insufflation system during MIS EXCEPT:
A. Insufflation pressures should be maintained at the lowest level that achieves necessary surgical conditions
B. The insufflator should be placed below the level of the surgical cavity whenever possible
C. The insufflator and tubing should be flushed with the insufflation gas before the tubing is connected to the cannula
D. A hydrophobic filter should be placed between the insufflator and insufflation tubing
E. Alarms should be turned on

Answer 4

B. The insufflator should be placed below the level of the surgical cavity whenever possible

Question 5

Which of the following maneuvers should be implemented to treat gas embolism?
A. Administration of inotropes
B. Decreasing ventilation
C. Increasing the anesthetic gas
D. Positioning the patient in reverse Trendelenburg position
E. Restricting fluids

Answer 5

A. Administration of inotropes

Question 6

Which of the following is a complication of fluid extravasation?
A.  Hypervolemia
B.  Hyponatremia
C.  Intraabdominal compartment syndrome
D.  Intravascular fluid overload
E.  Pulmonary edema

Answer 6

C. Intraabdominal compartment syndrome

Question 7

Which of the following fluids is isotonic?
A.  Glycine 1.5%
B.  Mannitol 5%
C.  Normal saline 0.9%
D.  Sorbitol 3%

Answer 7

C. Normal saline 0.9%

Question 8

The perioperative RN should report fluid deficits to the anesthesia professional and surgeon _______.
A. at regular intervals throughout the procedure
B. at the end of the procedure
C. when the patient is repositioned
D. every 30 minutes

Answer 8

A. at regular intervals throughout the procedure

Question 9

Which of the following precautions should be taken when lasers are used for endoscopic procedures?
A. The laser catheter sheath and laser fibers should be inspected for damage before use
B. The lengths of the catheter sheath and laser fiber should be confirmed before the procedure
C. The laser catheter sheath and laser fibers should be inspected for damage after use
D. The laser catheter sheath and laser fibers should be inspected every time they are removed from the patient
E. All of the above

Answer 9

E. All of the above

Question 10

How many perioperative team members are needed to properly dock the patient cart during computer assisted surgery?
A.  1
B.  2
C.  3
D.  4

Answer 10

B. 2

Question 11

Which of the following meet the criteria for a hybrid OR?
A. An OR equipped with dedicated imaging equipment
B. an OR with portable imaging equipment
C. A radiology suite with an anesthesia machine
D. All of the above

Answer 11

A. An OR equipped with dedicated imaging equipment

Question 12

Which of the following categories of patients should be assigned an RN circulator for procedures in a hybrid OR?
A. Patients with American Society of Anesthesiologists physical status 3 or higher
B. Patients receiving sedation or anesthesia
C. Patients undergoing procedures lasting more than 1 hour
D. Every patient undergoing an operative or other invasive procedure

Answer 12

D. Every patient undergoing an operative or other invasive procedure

Question 13

Which of the following zones around an MRI machine contains the scanner room itself?
A.  Zone 1
B.  Zone 2
C.  Zone 3
D.  Zone 4

Answer 13

D. Zone 4

Question 14

In what order should these actions by the perioperative team occur if a patient experiences a cardiac arrest during a procedure in a hybrid OR with an intraoperative MRI in use?

1. Resuscitation equipment should be brought in the room
2. The MRI scanner should be moved back into the garage storage area
3. The team should begin cardiopulmonary resuscitation

A. 1, 2, 3
B. 3, 2, 1
C. 1, 3, 2
D. 2, 3, 1

Answer 14

A. 1, 2, 3

Question 15

You are circulating on a MIS procedure. How would you prioritize connection of the following items at the start of the case?
 Light cord
 Bipolar cord
 Insufflation tubing
 Suction tubing
 Irrigation tubing

Answer 15

1. Light cord
2. Insufflation tubing
3. Bipolar cord
4. Suction tubing
5. Irrigation

Question 16

Per AORN’s Guideline for Minimally Invasive Surgery, what are the key points regarding fluid management?

Answer 16

Patients are at risk for hypothermia and fluid overload.
Fluids that will be used for irrigation and as distention media at a temperature other than room temperature should be warmed or cooled and stored in a safe manner. Must also monitor the amount of IV and irrigation fluids to prevent hyponatremia and hypervolemia, need to monitor amount of fluids dispensed and returned during surgery.