Lap/Robotic Surgery Flashcards
Some subspecialties for laparoscopic surgery?
general, urology, gyno
Some subspecialties for robotic surgery?
thoracic, cardiac, GI, urology
Robotic instruments have how many degrees of freedom?
7
Contraindications to laparoscopic surgery (8)?
diaphragmatic hernia, acute or recent MI, severe pulmonary disease, VP shunt, CHF or cardiac valve disease, hx of CVA/cerebral aneurysm, increased ICP, glaucoma
Contraindications to robotic surgery (2)?
poor PFT in robotic cardiac surgery bc single lung vent may be poorly tolerated; if prolonged T burg required in pts w hx of cerebral aneurysm
Type of surgical technique where Veress needle pierces abdominal wall at its thinnest point?
closed
Is closed placement of Veress needle done under direct vision?
no
Type of incision that is a midline vertical incision and is placed under direct vision?
open
Downside to open incision for placement of trocar?
it takes longer
Maintain IAP pressure
15 mm
Why is CO2 the gas of choice for pneumoperitoneum?
noncombustible and more soluble in blood, rapidly returned from periphery, eliminated by lungs, increases safety margin and decreases risk of gas embolism
What does hypercapnia do to myocardial contractility?
increases it
What causes the decreased venous return in pneumoperitoneum?
pooling of blood in the legs, caval compression, increased venous resistance
Increased intraabdominal pressure decreases or increases inotropy?
decreases
Does CO decrease or increase d/t increased intraabdominal pressure caused by pneumoperitoneum?
decrease
What does increased intraabdominal pressure do to intrathoracic pressure?
increases it
What type of effect does increased intrathoracic pressure have on neurohumoral factors?
increases release of catecholamines and vasopressin
Stimulation of peritoneal receptor does what?
increases release of catecholamines and vasopressin
Does increased intraabdominal pressure decrease/increase SVR?
increase
Three components of Da Vinci Surgical System?
1- control console 2-patient side cart (robotic arms) 3-equipment tower
What type of ANS output from CO2 absorption and neuroendocrine response to pneumoperitoneum?
sympathetic
SVR increases by what percentage from CO2 absorption/pneumoperitoenum?
20%
What does SV do in response to pneumoperitoneum?
decrease (decrease in venous return)
What does compression of the arterial vasculature do to myocardial wall tension and myocardial O2 demand?
increases the wall tension and increases the demand (ischemia and ST changes)