Laparoscopic & Robotic Flashcards
How many degrees of freedom does the robotic arm have?
7
laparoscopy entry methods (2)
- closed: spring-loaded Veress needle, blind insertion, aspirate-infuse-aspirate for placement
- open: midline vertical incision, direct vision
intra-abdominal pressure during laparoscopy
maintain under 15 mmHg
gas of choice for pneumoperitoneum
CO2 - noncombustible, soluble in blood, and eliminated in lungs
use with caution in patients with respiratory acidosis
can activate the sympathetic nervous system
laparoscopy - cardiac effects
- arrhythmias during inflation: sudden stretch of peritoneum causes vagal response - inflate slow, anticholinergic administration, deflate
- increase in SVR (20%), MAP: due to sympathetic activation and neuroendocrine hormone release (catecholamines, RASS, ADH): causes increased workload on heart
- SV, CO: increase if pressures <15, decrease if pressures are >15: give a fluid bolus before inflation
components of the Da Vinci Surgical System (3)
- control console
- patient side cart
- equipment tower
contraindications for laparoscopy (8)
- diaphragmatic hernia
- acute or recent MI
- severe pulmonary disease
- VP shunt
- CHF or valve disease
- CVA or cerebral aneurysm
- increased ICP
- glaucoma
hypercapnia
- decreased myocardial contractility
- increase arrhythmias
- pulmonary vasoconstriction
laparoscopy - respiratory effects
- diaphragm moves cephalad: caution with ETT movement
- decreased compliance, FRC and TLC
- increased peak pressures, RR and MV
laparoscopy - renal effects
- decreased blood flow and urine output
- increased creatinine clearance
- increased ADH secretion
laparoscopy - hepatic effects
-decreased blood flow
requirements for robotic surgery
paralysis
laparoscopy - nitrous oxide anesthesia
- can diffuse into abdomen and cause distension
- avoid if concern for PONV
laparoscopy - rule of 15s
- less than 15 minutes operative time
- 15 degrees Trendelenburg
- 15% above IBW
laparoscopy - DVT
-increased risk due to venous pooling in legs
