Laparoscopy

Question 1

What is Laparoscopy?

Answer 1

Laparoscopy is a minimally invasive surgery (key hole surgery) to look into the abdomen.

• It is done with a laparoscope (a thin, lighted tube).
• It is a type of endoscope but with a tiny video camera.

Question 2

What are the advantages of Laparoscopy?

Answer 2

1) Rapid return to function (can be done standing)
2) Relatively non-invasive
3) Quick to perform

Question 3

What are the disadvantages of Laparoscopy ?

Answer 3

1) expensive equipment
2) Requires a skilled surgeon (assistant)
3) video image is two dimensional
4) discomfort post-op due to insufflator (carbon dioxide)

Question 4

What orientation must the the horse be in during a Laparoscopy?

Answer 4

1) Standing

2) Recumbent under general anaesthesia

Question 5

What are the indications for Laparoscopy in the Equine patient

Answer 5

1) Chronic Weight loss
2) Colic (chronic/Acute)
3) intraabdominal haemorrhage
4) Peritonitis
5) Neoplasia
6) Adhesiolysis
7) Vaginal-uterine tears
8) rectal tears
9) Rectal prolapses
10) Mesocolic ruptures
11) Gastric ruptures
12) abdominal abscesses
13) Uterine artery ruptures
14) Cryptorchidectomy
15) ovariectomy
16) granulosa cell Ovariectomy
17) colopexy
18) cystorraphy
19) cystotomy
20) inguinal herniorrhapy
21) removal of infected umbilical remnants (RUMINENTS)
22) BIOPSY

BAsically anything thing abdominal

Question 6

What is the most frequent indication for Laparoscopy in the HORSE

Answer 6

Cryptorchidectomy

Question 7

What equipment is used during a Laparoscopy?

Answer 7

1) Laparoscope
2) Insufflator (carbon dioxide)
3) Long handle instruments
4) light source
5) monitor

Question 8

What insufflator is used in laparoscopy and how is it different to arthroscopy?

Answer 8

laparoscopy–> Carbon dioxide, requires a huge volume (>10L/min), 10-15mm Hg

Arthroscopy–> fluid

Question 9

What is a Verres Needle and What is it used for?

Answer 9

-used for belly taps

has a spring loaded obturator, which is cannulated so you can collected fluid samples without perforating gutt, it can be used to distend the abdomen too.

Question 10

What type of light source is required for Laparoscopy?

Answer 10

-requires a good light sources (Xenon 300 watts)

Question 11

What diameter and angle is required for a laparoscope?

Answer 11

Laparoscope–>10mm, 30 degree, 50cm long

Arthroscope–>4mm, 25730 degree

Question 12

What are the landmarks for Standing Laparoscopy?

Answer 12

1) 18th rib
2) internal abdominal oblique muscle
(half way between the dorsal and abdominal oblique muslce)
3) tuber coxae

Question 13

What is required for recumbent Laparoscopy?

Answer 13

1) use IPPV
2) tilt table at 30 degree angle (allows abdominal organs to move cranially, good for work in the caudal abdominal region)

Question 14

What type of ligature is placed internally during a laparoscopy?

Answer 14

Roeder Knot

requires:

• introducers sleeve
• pushrod
• and ligature

Question 15

What is the downfall for PDS clips in Horses

Answer 15

to small!!!!

they are great for small animals use but they are not really used in Large animal

Question 16

What are some post operative complications of Laparoscopy?

Answer 16

1) post op discomfort (carbon dioxide+ abdominal fluid –> carbonic acid= irritating to the peritoneal lining)
- can be fixed with banamine
2) Haemorrhage (caution with the caudal epigastric artery and vien)
3) local incision infection

Question 17

What type of local block is used for laparoscopy?

Answer 17

inverted L block with lidocaine

Question 18

Which is easier to perform Laparoscopy or Thoracoscopy and why?

Answer 18

Thoracoscopy:

Structures in the thorax are anchored tightly and require less retraction

Question 19

Why do thermal injuries occur from electrosurgery during minimally invasive procedures?

Answer 19

A portion of the activated instruments used to deliver the electrical current may be beyond the viewing range

Question 20

To avoid cardiovascular compromise, gas in the THORAX should be maintained below_____?

Answer 20

8-10mmhg

Question 21

To avoid overinflation, intraabdominal pressure should be maintained at how many meg?

Answer 21

10-15mmhg

Question 22

What effects does laparoscopy have on the cardiopulmonary function of an anesthetize patient?

Answer 22

1) decrease tidal volume
2) increase intrapulmonary shunting
3) increase dead space