Laparoscopy Flashcards
What procedures can you do with laparoscopy
-OVE
-OVH
-Liver biopsy
-Abdominal cryptorchidectomy
-Lap assisted cystotomy
-Lap assisted gastropexy
-Lap assisted intestinal biopsy
-Lap assisted feeding tube placement
T/F: most owners would choose laparoscopy over open despite higher cost
true
Is laparoscopy financially feasible in general practice
Yes
What are the advantages of laparoscopy to the patient
1) Faster reocvery
2) Decreased post-operative complications
3) Shorter hospitalization
4) Decreased pain (lower score, more activity, and glucose/cortisol)
What are the advantages of laparoscopy to the doctor
1) Improved exposure
2) Bright light
3) Magnification
What might be the contraindications for laparoscopy *
1) Patient relate: hemodynamic instability, respiratory comorbidities, previous abdominal surgery / adhesion formation
2) Disease related: Diaphragmatic hernia, large abdominal mass, septic peritionitis, intra-abdominal malignancy, increased cranial pressure, Pregnancy
3) Portal hypertension and coagulations
What are basic laparoscopy equipment
-Xenon or LED light source
-Camera
-Monitor
-Insufflator
-Trocars and cannulas
-Telescope
What are the different type of telescopes
1) Angled scope 30 degrees - good for arthroscopy
2) Straight angle scope 0 degrees
When doing laparoscopy, what are the three ways to create a capnoperitoneum
1) Veress Needle
2) Hasson Technique
3) SILS port
When doing laparoscopy, how should you be positioned
Working in the cranial direction, working in line towards the monitor
SCOP-
1) Surgeon
2) Organ
3) Camera
4) Surgeon
What are complications with entry and trocar placement
Happens with veress or trocar
1) Organ perforation or laceration
-Bladder is most common (needs to be emptied prior)
2) Spleen trauma- often will not be major and will stop bleeding
3) Veress Needle not in abdomen and insufflates the SQ
With laparoscopy you should always be prepared for
Conversion
-Clip
-Prepped
-Draped
surgical approach with laparoscopy
final step as an open surgery
benefit = visualization, minimize tissue trauma
laparoscopic assisted surgery
What is the benefit of laparoscopic assisted surgery
benefit = visualization, minimize tissue trauma
What are common reasons for conversion to open surgery
1) Hemorrhage - emergent or blocking vision
2) Equipment malfunction - loss of insufflation
3) Organ trauma
4) Unanticipated intra-op findings (ie diaphragmatic hernia)
5) Anesthetic complication
6) Time: when learning
What are procedures that laparoscopy is very helpful with
1) Biopsy: liver and pancreas
2) Ovariectomy
3) Ovarian remnant - good magnification
4) Cryptorchidectomy
What should you do when taking a liver biopsy
take from periphery edge, hold for 30 seconds
get at least 3 different lobes
What procedures can you do laparoscopic assisted
1) Ovariohysterectomy
2) Preventative gastropexy
3) Full thickness small intestinal biopsy
4) Gastrostomy and jejunostomy feeding tube placement
5) Intestinal foreign body - hard to explore
6) Laparoscopic assisted cystotomy
How do you do Lap-Assisted Ovariohysterectomy
-Ovarian pedicle, suspensory, broad ligament
-Exteriorize ovaries and uterine horn through caudal abdominal incision
-Ligate uterine body / cervix externally
-Extend caudal cannula site
How big is your incision for laparoscopic assisted gastropexy
3cm
How big is your incision for lap assisted cystotomy
5mm
Lap assisted cystotomy allows for
1) Better visualization and magnification
2) Copious lavage and suction
3) Small incision (only 5mm) instead of all the way to apex
4) Decreased bladder manipulation
5) Can insufflate and combine with other abdominal procedures
What are the disadvantages to lap assisted cystotomy
1) Large stones not allowed (>5mm)
2) Gravel pit is hard because it takes a lot of time to pull each the stones through the canula
What case selection should you do for lap assisted cystotomy
1) Males or Females
2) Dogs and cats
3) smallish uroliths 5mm or less
How is the set up of lap assisted cystotomy
stand at side of patient looking caudal at screen
How are the cannulas positioned when doing lap assisted laparoscopy
Two cannula approach
Camera more cranially
working portal more caudal
When doing lap assisted cystotomy, what should you do if you have a difficult female catherization
Normograde catherization through stab incision in bladder
exit catheter through vulva
suture 2nd catheter and pull into bladder retrograde
How much tension should you have when manipulating the bladder to exteriorize
moderate tension - allows the stones to be maintained in the bladder neck
if you dont have enough tension they will droop down
When doing a temporary cystopexy to seal and stabilize the bladder, where do you suture the bladder
to the external rectal sheath
How do you flush the bladder when doing lap assisted cystotomy
Large urinary catheter placed intraop in urethra
Sterile fluid with pressure bag flushed
Sterile extension set attached to the urinary catheter
Surgeon controls the flow
How do you get stones out the cannula when doing lap assisted cystotomy
Postive pressure of saline flushed then then suction
telescope remains in the top of the cannula
What should you do after removing stones
always take rads to make sure you got them all
