da Vinci X and XI I&A Flashcards
Traditional Instruments - Design, Use, Advantages, Challenges
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.
Laparoscopic instruments - Design, use, advantage, challenge
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.
Robotic instruments: Design, uses, Advantages, Challenges
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
Features of da Vinci Xi instruments – Flexibility
8mm w/ multiple tip designs
range of motion greater than the hand
7 degrees of freedom
90 degrees of articulation
540 degrees of rotation
Features of da Vinci Xi instruments – Control
Remote center technology
Intuitive motion: alignment of the instrument tip to hand movement
Motion scaling
tremor filtration
Architecture - Housing
EndoWrist component that interfaces with the robotic patient cart.
What does the housing contain - side
Release button - used to remove the instrument
Maximum use indicator - turns red when the instrument has reaching its max us
What does the housing contain - top
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
What does the housing contain - back
The flush ports - used for cleaning the insides of the instruments
What does the housing contain - front
Discs - translate the movements at the surgeons hand controls to the movements of the shaft, wrist, and jaws
Components of the jaws
wrist, tines, tips
Closing force - definition, use
force generated at the tip of an instruments jaws
pre-programed, can be higher or lower depending on instrument type.
jaw length - definition
distance between distal joint of wrist and distal tip of jaws
jaw open angle - definition
angle between tines when jaws are completely open
Jaw inner surface geometry - definition and 2 notable features
shape of the interior surface of the jaws
- Serration
- Fenestration
Serration - definition
the presence of “teeth” along the inner surface of the jaw.
Fenestration - its benefit
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
What happens if a higher closing force is applied
can create more pressure on the tissue, which can lead to relatively higher tissue trauma
What is the benefit of a higher surface area
allows for lower pressure applied to the tissue
Serration - benefit / disadvantage
Benefit: a more firm grip
disadvantage: higher tissue trauma
Lives/ fires - definition
the number of uses for which instruments are indicated
When is an instrument life/fire used?
when the instrument has been installed and is brought under surgeon control
What happens when the instrument is out of lives/fires?
it will not engage, and a message on the system will state that the instrument has expired.
How many lives/fires for each:
8mm?
training instruments?
Clip appliers?
8mm - 10-18
training - 30
clip appliers - 100
What happens if a higher closing force is applied
can create more pressure on the tissue, which can lead to relatively higher tissue trauma
Where can the number of lives/fires be found?
in the settings tab, under uses remaining.
Remote center - definition
a fixed point in space around which the surgical arms and cannulas move. Represented by a thick black band near the distal end
Benefit of remote center technology
enables the system to maneuver instruments and endoscopes in the surgical site while exerting minimal force on the patients body wall
Movements of EndoWrist instruments are described relative to: _____________
the remote center
What are the 7 degrees of freedom?
- Insertion
- External Yaw
- External Pitch
- Roll
- Internal Yaw
- Internal Pitch
- Grip
Insertion -definition
the direction of movement that adjusts the depth of the instrument tip
External yaw - definition
side-to-side rotation around remote center
External pitch - definition
up and down - around remote center
Roll - definition
rotation of the instrument shaft around its own central axis
Internal yaw - definition
Side-to-side rotation of the instrument jaws via the distal joint of the instrument wrist
Internal pitch - definition
up and down rotation of the instrument tips via proximal joint of the instrument wrist
Grip - definition
opening and closing of the instrument jaws
Manipulation
any movement of tissue, with or without grabbing it between the jaws
Grasping
grabbing tissue within the jaws
Retracting
lifting or pulling tissue by grasping or manipulating- tissue often left in place for periods of time (static)
Dissecting
separation of tissue by using jaws in and opening or pushing/sweeping movement in order to expose surrounding structures
cutting
incising without energy ( cold cutting)
Needle driving
driving needles through tissue
suture tying
forming knots and tightening knots in suture
suture cutting
cutting through suture
needle handling
gripping needles, but not driving through tissue
suture handling
gripping suture without damaging suture
coagulating
heating of tissue that causes the tissue proteins to form coagulum that seals the bleeding sites
transecting
division by cutting across ( with or without energy)
Cadiere Forceps : lives, jaw inner surface geometry, intended use
18
Serrated, single fenestration
Dissecting, grasphing, manipulating, and retracting tissue
