Fundamentals of Laparoscopic and Robotic Urologic Surgery Flashcards
In patients with severe chronic obstructive pulmonary disease (COPD), further studies (i.e., arterial blood gases and pulmonary function tests) are required because of the physiologic effects of the ____
In patients with severe chronic obstructive pulmonary disease (COPD), further studies (i.e., arterial blood gases and pulmonary function tests) are required because of the physiologic effects of the CO 2pneumoperitoneum.
Contraindications to laparoscopic surgery include
uncorrectable coagulopathy, intestinal obstruction unless there is an intention to treat, significant abdominal wall infection, massive hemoperitoneum or hemoretroperitoneum, generalized peritonitis, and suspected malignant ascites.
When is the preferred time to perform an indicated laparoscopic surgery on a pregnant patient?
The second trimester is a preferred time for necessary surgery, given the completion of fetal organogenesis and reduced chance of inducing labor.
Where is the preferred site for insertion of a veress needle when extensive intraabdominal adhesions are expected ie the palmer point
When extensive intra-abdominal or pelvic adhesions are suspected, careful consideration must be given to the possible site of Veress needle insertion as well as to obtaining open access with a Hassonstyle cannula. The Palmer point (subcostal in the midclavicular line on the left side) is the preferred site for Veress needle insertion when extensive intra-abdominal adhesions are suspected (Palmer, 1974). Alternatively, in patients with suspected adhesions, a retroperitoneal approach may be preferable to a transperitoneal approach, or the procedure can be initiated retroperitoneally and the peritoneum entered via the retroperitoneal access
Which of the ff results in a greater chance of rhabdomyolysis from flank pressure
A BMI greater than or equal to 25, use of a kidney rest, and full-table flexion as opposed to half-table flexion were associated with increases in interface pressure; of these, use of the kidney rest was believed to be the most detrimental, and its use beyond 20 to 30 minutes was discouraged. Therefore male patients with a BMI of 25 or higher undergoing laparoscopic surgery in the lateral position with the kidney rest elevated and the table completely flexed are at highest risk of developing rhabdomyolysis from flank pressure. In this study the unaugmented operating table mattress was superior to egg crate or gel padding as an augmenting surface material; egg crate padding was equal or superior to the more expensive gel padding.
Which is routinely done as preoperative preparation of a patient for laparoscopic or robotic Urologic surgery
Contraindications to laparoscopic or robotic surgery include uncorrectable coagulopathy, intestinal obstruction unless treatment is intended, significant abdominal wall infection, massive hemoperitoneum or hemoretroperitoneum, generalized peritonitis, and suspected malignant ascites.
Principles to remember in using monopolar electrosurgical devices during laparoscopy include:
The insulation of the instrument should be routinely checked for damage before use
Disadvantages of ultrasonic sealing or cutting instruments compared to monopolar devices include:
Longer time to cool after use
Which electrosurgical device is recommended for use in patients with pacemakers?
ultrasonic device
Which is the proper sequential order to confirm the proper entry of a Veress needle intraperitoneally?
After placement of the Veress needle, insufflation should never be initiated unless all of the signs for proper peritoneal entry (negative aspiration, easy irrigation of saline, negative aspiration of saline, positive drop test result, and normal advancement test) have been confirmed.
The characteristic of carbon dioxide gas that makes it ideal for use as an insufflant is:
CO 2 is the most commonly used insufflant for laparoscopic and robotic surgery and is favored by most minimally invasive surgeons thanks to its properties (colorless, noncombustible, very soluble in blood, and inexpensive). Prolonged postoperative distention of the abdomen does not occur because CO 2 is quickly absorbed (Wolf and Stoller, 1994). It is highly soluble in water and easily diffuses in body tissues. It readily moves out of the peritoneal cavity as a result of a high diffusion gradient caused by the difference in concentration of CO 2 between the intraperitoneal space and the surrounding components (e.g., blood). However, the characteristic of rapid absorption, which lessens the chance of a CO 2 gas embolus, may also lead to potential problems (e.g., hypercapnia, hypercarbia, associated cardiac arrhythmias). In particular, patients with COPD may not be able to compensate for the absorbed CO 2 by increased ventilation; this may result in dangerously elevated levels of CO 2 in these patients, thereby necessitating the direct testing of arterial blood gases during laparoscopy or robotics in the pulmonary compromised patient. Carbon dioxide also stimulates the sympathetic nervous system, which results in an increase in heart rate, cardiac contractility, and vascular resistance. Last, CO 2 is also stored in various body compartments (e.g., viscera, bones, muscles). After prolonged laparoscopic or robotic procedures it may take hours before the patient has eliminated the extra CO 2 that has accumulated in these storage areas; again, this is more often the case and a problem in patients with pulmonary compromise (Lewis et al., 1972; Puri and Singh, 1992; Tolksdorf et al., 1992; Wolf and Stoller, 1994). Therefore, as previously noted, all patients, and in particular those with pulmonary disease, must be closely monitored after a lengthy laparoscopic or robotic procedure for possible signs or symptoms of hypercarbia; indeed, their greatest chance of compromise as a result of hypercarbia may occur after extubation in the postanesthesia recovery room.
