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Technology > Laparoscopy > Flashcards

Laparoscopy Flashcards

1
Q

components lap stack

A 
monitor 
gas insufflator
computer
light source
digital camera control
printer
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2
Q

why co2 for insufflation

A

non combustible

physiological

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3
Q

components of rigid endoscope

A

optical system - distal tip objective lens, relay system and a diopter lens which magnified and brings coherent image to eye piece

mechanical sheath, protection, allows sterilsation

non coherent glass fibre system to transmit light

instrument flow channel

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4
Q

light transmission

A

Light is guided to the tip of the endoscope via a noncoherent fi bre bundle
which starts in the upward projecting “light” pillar. This is attached, via a noncoherent
fi bre-optic light guide, to the external light source.

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5
Q

distal tip objective lens

A

The distal tip objective lens can be angled off the 0° to give an oblique view – the
most commonly used angles in urology are 12°, 30°, and 70°. By rotating these
scopes on their axis, a differential fi eld of view can be achieved with minimum
physical trauma to the structure being examined.

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6
Q

light source

A

Generated light typically comes from a halogen bulb, which gives a softer light, or
a xenon bulb, which gives a brighter white light

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7
Q

effects pneumo -5

A 
vagal stimulation
decreased venous return
decreased renal function
gas embolus
increased airway pressure
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8
Q

correc site surgery -5

A

follow NHS NPSA guidelines
meet patient preop mark with indelible ink
ward staff review documentation and confirm marker
prior to anaesthesia review notes and mark
prior to surgery WHO checklist and review mark

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9
Q

ideal insufllation gas 6

A 
physiologically inert
highly soluble in blood
colourless
chemically stable
widely available
inexpensive
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10
Q

air as insufllant

A

risk combustion and air embolus

advantage no acidosis or hypercapnia

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11
Q

nitrogen oxide

A

no acidosis
high solubility
risk combustion

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12
Q

helium

A

inert non combustible
dissolve slowly risk embolism
expensive

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13
Q

disadvantage co2

A

hypercapnia

peritoneal irriation

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14
Q

complications co2 insufflation 5

A 
vagal stimulation
decreased venous return
renal function
gas embolus
increased airway pressure
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14
Q

complications co2 insufflation 5

A 
vagal stimulation
decreased venous return
renal function
gas embolus
increased airway pressure
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15
Q

metbolic consequenes of co2 4

A

hypercarbia
acidosis
these cause vasodilatation and decreased CO
stimulate SNS resulting in tachycardia and VC

16
Q

air embolus and co2 risk vs air

A

risk low due to rapid absorption in blood and ability of blood to transport high levels
five times volume of co2 needed at 200mls vs air to have embolic effect

17
Q

diagnosing air embolus

A

arrythemia
myocardial ichaemia
increased central venous pressure
pulmonary hypertension

18
Q

managing air embolus

A 
inform surgeon 
stop insufflation
venitalte 100% oxygen
left lateral decubitus position
adequate hydration
central venous catheter aspirate co2
resusicitate
fluids
vasopressors 
inotropes
drugs dilate pulmonary circulation
hyperbaric oxygen
19
Q

why oxygen in co2 embolism

A

The patient should be ventilated with 100% oxygen in order to wash out carbon dioxide and improve ventilation perfusion mismatch and hypoxemia.

20
Q

why left lateral decubitus position in air embolism

A

The patient should be placed in a steep-head down, left-lateral decubitus (Durant’s) position in order to allow gas bubbles to rise to the apex of the RA and to prevent entry into the pulmonary artery

21
Q

advantages rod lens system

A 
durability
superior light passage
and image quality
reduced diameter of instrument
colour reproduction
22
Q

how does optic fibre work

A

via total internal reflection
optic fibres grouped in parallel fashion and arrnaged in external plastic sleeve

in digital system used CMOS chip with photons striking charge coupled device

Technology (24 decks)

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