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Intuitive CAST > da Vinci X and XI I&A > Flashcards

da Vinci X and XI I&A Flashcards

1
Q

Traditional Instruments - Design, Use, Advantages, Challenges

A

Design: larger & handheld at patient-side

Use: primarily open surgery, but also used in MI procedures

Adv: intuitive instrument control, high level of accessibility, lower costs, well established work-flow

Challenge: invasive - larger incisions sites, ergonomically challenging.

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2
Q

Laparoscopic instruments - Design, use, advantage, challenge

A

Design: long-shafted, and handheld at patient side

use: laparoscopic procedures, also robotic

Adv: MI incisions, shorter length of stay, recovery time, risk of infection

Challenge: counterintuitive and limited instrument control. 2D vision, awkward positions.

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3
Q

Robotic instruments: Design, uses, Advantages, Challenges

A

Design: long-shafted, mounted on patient cart at patient side

Use: robotic procedures

Adv: MI, Ergo friendly, intuitive control, greater range of motion than the hand. built in safety features

Challenge: initial learning curve

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4
Q

Features of da Vinci Xi instruments – Flexibility

A

8mm w/ multiple tip designs
range of motion greater than the hand
7 degrees of freedom
90 degrees of articulation
540 degrees of rotation

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5
Q

Features of da Vinci Xi instruments – Control

A

Remote center technology
Intuitive motion: alignment of the instrument tip to hand movement
Motion scaling
tremor filtration

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6
Q

Architecture - Housing

A

EndoWrist component that interfaces with the robotic patient cart.

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7
Q

What does the housing contain - side

A

Release button - used to remove the instrument

Maximum use indicator - turns red when the instrument has reaching its max us

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8
Q

What does the housing contain - top

A

Grip release socket - used to open or move grips manually during system fault

Cautery cord interface - used to connect monopolar and bipolar energy instruments to an ESU

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9
Q

What does the housing contain - back

A

The flush ports - used for cleaning the insides of the instruments

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10
Q

What does the housing contain - front

A

Discs - translate the movements at the surgeons hand controls to the movements of the shaft, wrist, and jaws

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11
Q

Components of the jaws

A

wrist, tines, tips

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12
Q

Closing force - definition, use

A

force generated at the tip of an instruments jaws

pre-programed, can be higher or lower depending on instrument type.

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13
Q

jaw length - definition

A

distance between distal joint of wrist and distal tip of jaws

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14
Q

jaw open angle - definition

A

angle between tines when jaws are completely open

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15
Q

Jaw inner surface geometry - definition and 2 notable features

A

shape of the interior surface of the jaws

  • Serration
  • Fenestration
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16
Q

Serration - definition

A

the presence of “teeth” along the inner surface of the jaw.

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17
Q

Fenestration - its benefit

A

The presence of a window within the times of a jaw

allows for some tissue to protrude through the window in the tines, allowing for a more secure grip

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18
Q

What happens if a higher closing force is applied

A

can create more pressure on the tissue, which can lead to relatively higher tissue trauma

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19
Q

What is the benefit of a higher surface area

A

allows for lower pressure applied to the tissue

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20
Q

Serration - benefit / disadvantage

A

Benefit: a more firm grip
disadvantage: higher tissue trauma

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21
Q

Lives/ fires - definition

A

the number of uses for which instruments are indicated

22
Q

When is an instrument life/fire used?

A

when the instrument has been installed and is brought under surgeon control

23
Q

What happens when the instrument is out of lives/fires?

A

it will not engage, and a message on the system will state that the instrument has expired.

24
Q

How many lives/fires for each:
8mm?
training instruments?
Clip appliers?

A

8mm - 10-18
training - 30
clip appliers - 100

25
Q

What happens if a higher closing force is applied

A

can create more pressure on the tissue, which can lead to relatively higher tissue trauma

25
Q

Where can the number of lives/fires be found?

A

in the settings tab, under uses remaining.

26
Q

Remote center - definition

A

a fixed point in space around which the surgical arms and cannulas move. Represented by a thick black band near the distal end

27
Q

Benefit of remote center technology

A

enables the system to maneuver instruments and endoscopes in the surgical site while exerting minimal force on the patients body wall

28
Q

Movements of EndoWrist instruments are described relative to: _____________

A

the remote center

29
Q

What are the 7 degrees of freedom?

A
  1. Insertion
  2. External Yaw
  3. External Pitch
  4. Roll
  5. Internal Yaw
  6. Internal Pitch
  7. Grip
30
Q

Insertion -definition

A

the direction of movement that adjusts the depth of the instrument tip

31
Q

External yaw - definition

A

side-to-side rotation around remote center

32
Q

External pitch - definition

A

up and down - around remote center

33
Q

Roll - definition

A

rotation of the instrument shaft around its own central axis

34
Q

Internal yaw - definition

A

Side-to-side rotation of the instrument jaws via the distal joint of the instrument wrist

35
Q

Internal pitch - definition

A

up and down rotation of the instrument tips via proximal joint of the instrument wrist

36
Q

Grip - definition

A

opening and closing of the instrument jaws

37
Q

Manipulation

A

any movement of tissue, with or without grabbing it between the jaws

38
Q

Grasping

A

grabbing tissue within the jaws

39
Q

Retracting

A

lifting or pulling tissue by grasping or manipulating- tissue often left in place for periods of time (static)

40
Q

Dissecting

A

separation of tissue by using jaws in and opening or pushing/sweeping movement in order to expose surrounding structures

41
Q

cutting

A

incising without energy ( cold cutting)

42
Q

Needle driving

A

driving needles through tissue

43
Q

suture tying

A

forming knots and tightening knots in suture

44
Q

suture cutting

A

cutting through suture

45
Q

needle handling

A

gripping needles, but not driving through tissue

46
Q

suture handling

A

gripping suture without damaging suture

47
Q

coagulating

A

heating of tissue that causes the tissue proteins to form coagulum that seals the bleeding sites

48
Q

transecting

A

division by cutting across ( with or without energy)

49
Q

Cadiere Forceps : lives, jaw inner surface geometry, intended use

A

18
Serrated, single fenestration
Dissecting, grasphing, manipulating, and retracting tissue

Intuitive CAST (8 decks)

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