Exam 3 general, gynecological, breast P2 (7/15)

Question 1

Condyloma Introperatively:

• patient position
• type of anestesia

Answer 1

• lithotomy, may change to prone if rectal or supine if in throat
• general anesthesia

S70

Question 2

What equipment is necessary for Condyloma removals?

Answer 2

• Laser masks
• Smoke (plume) evacuation system
• because it is a laser evacuation procedure

S70

Question 3

What causes pelvic organ (bladder, vagina, etc) prolapse?

Answer 3

• Weakened pelvic floor r/t:
  
  • delivery, repair would be postponed
  • aging
  • previous pelvic surgery

S72

Question 4

What are the three types of prolapse discussed in lecture?

Answer 4

• Cystocele- anterior prolapse (bladder)
• Rectocele-posterior prolapse (rectum)
• Enterocele (intestine)

S72

Question 5

Repair Procedures Intraop

• patient position
• type of anestheisa

Answer 5

• lithotomy
• GETA
  
  • ETT: if the case is longer as with double repair
  • LMA: minor prolapse
• SCIP
• Foley catheter

73

Question 6

What medical device do patients typically go home with post prolapse repair?

Answer 6

Foley catheter (ensures urethra won’t be obstructed)

S73- ANDY?

Question 7

What are the three types of hysterectomy?

Answer 7

• partial (uterus)
• total (uterus and cervix)
• total with removal of ovaries and fallopian tubes

S74

Question 8

What are the 3 different approaches to a hysterectomy?

Answer 8

• abdominal aka bikini cut
• vaginal
• LAVH (laparoscopic assisted vaginal hysterectomy)

S75

Question 9

What two types of cut are used in hysterectomies if an abdominal approach is indicated?

Answer 9

• Pfannenstiel (bikini cut)
• Midline

S75

Question 10

What is the most common surgical approach for hysterectomies?

Answer 10

LAVH

Laparoscopic assisted vaginal hysterectomy

S75 - ANDY?

Question 11

Intraop considerations for hysterectomies

Answer 11

• Position:
  
  • dorsal lithotomy
  • legs in stirrups
  • steep trendelenburg
  • (LAVH is supine and lithotomy)
• General anesthesia- GETA
• Foley catheter
• SCIP
• Bowel prep- pt might be dehydrated
• Bradycardia?? if pulling on cervix, know where robinol is
• PONV?? girl, belly, gyn, girl parts etc

S76

bolded is what is on PPT slide

Question 12

When was robotic surgery first used and when?

Answer 12

• 1st used in gyn for fallopian tubal anastomoses
• 1999

S78

Question 13

Robotic surgery has 3 dimensional vision what are the pros and cons of this?

Answer 13

• improved dexterity (safer, b/c we dont tend to cut as many nerves and ligaments)
• increased cost
• added operating room time

S78

Question 14

intraop considerations for robotic surgeries

Answer 14

• General anesthesia
• Positioning (pt is in trendelenburg) and staying there!!! (there is no room in the OR)
• SCIP antibiotics
• Good muscle relaxation
• Fluid restriction!!! (less than 500cc. b/c they are upside down, airway becomes extremely edematous)

S79

Question 15

What benefits does robotic surgery provide?

Answer 15

Increased safety profile

Ex. Impotence rates decreased post implementation of robotic surgery for prostatectomies

andy

Question 16

What positioning is typically used with robotic surgery?

Answer 16

Extreme Trendelenburg

andy

Question 17

Robotic surgeries necessitate less fluid administration. Why?

Answer 17

Positioning (severe trendelenburg) results in extreme facial and airway edema.

S79- andy