L6: Minimally Invasive Surgery

Question 1

Def of Minimal Invasive Surgery

Answer 1

Question 2

History of Minimal Invasive Surgery

Answer 2

Question 3

Minimal Invasive Surgery approaches

Answer 3

Question 4

Most of the trauma of an open procedure is inflicted because the surgeon must have a ……. that is large enough to give adequate exposure for safe dissection at a target site

Answer 4

wound

Question 5

……….. prolongs recovery time and, by reducing mobility, contributes to an increased
incidence of pulmonary atelectasis, chest infection, paralytic ileus and deep venous
thrombosis

Answer 5

Wound pain

Question 6

The wound is often the cause of morbidity, including infection, dehiscence, bleeding, herniation, and nerve entrapment.

Answer 6

..

Question 7

Mechanical and human …… cause additional trauma. Body wall retractors can inflict localized damage that may be as painful as the wound itself.

Answer 7

retractors

Question 8

……. of any body cavity to the atmosphere also causes morbidity through cooling and fluid loss by evaporation.

Answer 8

Exposure

Question 9

In the manual ……. of intestinal loops, the surgeon and assistant disturb the peristaltic activity of the gut and provoke adynamic ileus

Answer 9

handling

Question 10

• In contrast, during laparoscopy, the retraction is provided by the low-pressure pneumoperitoneum, giving a diffuse force applied gently and evenly over the whole-body wall, causing minimal trauma.
• The incidence of postsurgical adhesions is reduced using minimally invasive approaches because there is less damage to delicate serosal coverings.

Answer 10

…

Question 11

Adverse Effects of open Surgery

Answer 11

Question 12

Advantages of minimal access surgery

Answer 12

Question 13

Preparation for minimal access surgery

Answer 13

Question 14

Contraindications to laparoscopy

Answer 14

Question 15

Increased risk during laparoscopic surgery

Answer 15

Question 16

• It used to be thought that the conditions listed here were contraindications to laparoscopy.
• However, with increasing expertise and use of laparoscopic techniques, many of these patients can be safely operated on by an experienced laparoscopic surgeon.

Answer 16

..

Question 17

Equipment for minimal access surgery

Answer 17

Question 18

The perfect gas for insufflation during laparoscopy must have the next characteristics:

Answer 18

Question 19

Principles of minimal access surgery

Answer 19

• Establishing a Pneumoperitoneum
• placement of laparoscopic ports
• Closure of laparoscopic port sites

Question 20

Methods of Establishing a Pneumoperitoneum

Answer 20

There are two accepted methods: open (Hassan) or closed (Verress)

a) The open method is preferred by the Royal College of Surgeons (Eng).

b) The Verress method is safe in experienced hands.

Question 21

Physiological consequences of a pneumoperitoneum Laparoscopic surgery induces multiple physiological responses in the patient due to:

Answer 21

a) Positioning of the patient to extreme positions (eg head up).

b) Mechanical effects of elevated intra-abdominal pressure due to insufflation of gas (eg decreased venous return).

c) Absorption of CO2 and biochemical changes.

Question 22

Summary of Hemodynamic Changes due to CO2 insufflation

Answer 22

Question 23

placement of laparoscopic ports

Answer 23

Question 24

Closure of laparoscopic port site

Answer 24

Question 25

Limitations of minimal access surgery

Answer 25

Question 26

Operative problems

Answer 26

Question 27

Future of laparoscopy

Answer 27