Kapitel 24 - Laparoscopy

Question 1

What size rigid telescope are most commonly used? And what angulation?

Answer 1

5 mm diameter scope, 30 degrees

Question 2

What are types of light sources and which is the best one?

Answer 2

Halogen or xenon.
Xenon, similar to natural light.

Question 3

What is ideal insufflation?

Answer 3

8-10 mm hg and should not exceed 15 mm hg

Question 4

What is different about insufflation in the thorax vs abdomen?

Answer 4

You usually don’t need to insufflate the thorax since you have the ribs.

Question 5

What gas is used for insufflation?

Answer 5

Co2 is preferred

Question 6

What are some proposed cons to carbon dioxide?

Answer 6

Might have determinantal effects on cellular, hormonal and immunologic functions

Question 7

What are some of the pros to carbon dioxide?

Answer 7

It is cheap and rapidly excreted from the circulation. It does not support combustion (like nitrous oxide) and can therefore be used during electro surgery.

Question 8

What are some topical hemostatic agents that have been used in laparoscopic surgery?

Answer 8

Gelitina sponges (Gelfoam) and oxidized regenerated cellulose (surgical). Fibrin glue have become available in humans.

Question 9

What is the benefit of laparoscopic hemostatic clips?

Answer 9

Minimize instrument exchanges and surgical time

Question 10

Why would we use monopolar electrocautery with caution in laparoscopic surgery?

Answer 10

Risk of iatrogenet damage by passing of a current into tissue of there is a defect of the insulation. Direct coupling injuries can also occur if the electrical current comes into contact with instruments.

Question 11

Why is bipolar cautery safer in laparoscopic surgery?

Answer 11

Because it is usuallt of lowe voltage and the current is passed only between the tips of the instrument.

Question 12

How does a vessel sealing device work?

Answer 12

They work through pressure exerted on tissue when the tissue is crushed in the tis of the device, followed by application of bipolar or ultrasonic energy.

Question 13

How big of vessels does the ligasure (force triad) seal?

Answer 13

7 mm

Question 14

Endoscopic stapler- What are lengths and staple sizes of endoGIA? Viktigt att veta!! (tydligen)

Answer 14

The most common one is 12 mm in diameter. The endo GIA is available in 30, 45 and 60 mm. The stample leg length are 2.0, 2,5, 3.5 and 4,8.

Most commonly used 3,5 staples

Question 15

What are the most common laparoscopic needle holders?

Answer 15

Parrot jaw needle holder

Question 16

What are the 3 types of one-lung ventilation?

Answer 16

Selective intubation, bronchial blockers and double-lumen endobronchial intubation.

Question 17

Discuss selective intubation

Answer 17

Requires broncoscopic placement and involves the placement small diameter regular endotracheal tube into one mainstem bronchi. It can be hard to keep the tube in position and care must be taken not to occlude the early branching cranial lobar bronchi, especially on the right side

Question 18

Discuss bronchial blockers:

Answer 18

Consists of an endotracheal tube with a small diameter balloon tip

Question 19

Describe physiologic changes with one lung ventilation:

Answer 19

A significant ventilation-perfusion mismatch occurs because nonventilated lung remain perfused. Although studies have shown that no large effects on oxygen delivery in helathy dogs occure,

Has been used clinically for formation of pericardial windows, subphrenic pericardiectomy, lunglobectomy and thymoma excision