Lecture 23 - Minimally Invasive Surgery Flashcards
Minimally invasive surgery _____ damage to tissues.
reduces
Minimally invasive surgery is performed via _____ incisions; is not “_____”.
smaller, open
Minimally invasive surgery usually involves a _____. What is the suffix for a procedure like this?
camera, -oscopy
Endoscopy was started by who? What did this person do?
Philipp Bozzini;
Developed a light conductor called the Lichtleiter and directed light into the internal cavities of the body
What are 5 advantages to MIS?
- Less blood loss (can visualize better)
- Less scarring and less damage to body
- Shorter hospital stays
- Decreased pain
- Earlier resumption of normal activities
What are 3 main disadvantages of MIS?
- Operations may last longer (greater learning curve for surgeon and requires advanced training)
- Operations may cost more (equipment is costly)
- May be more difficult for the surgeon
What are 7 other disadvantages to MIS?
- $$$
- Effects of pneumoperitoneum or pneumothorax
- Trocar insertion
- Ergonomics
- Pressure ischemia during long procedures
- Gas emboli
- Equipment failure
What are some common procedures done by MIS?
Laparoscopy, arthroscopy, endoscopy, cystoscopy, hysteroscopy, biopsies, orthopedic procedures
What types of procedures would use a flexible camera?
Colonoscopy, laryngoscopy, bronchoscopy, sinoscopy
What types of procedures would use a rigid camera?
Laparoscopy, arthroscopy, thoracoscopy, sinoscopy
How does the camera light source connect to the scope?
Through fiberoptic cable
What light source is preferred for a camera?
Xenon light source
What is the advantage to having a videocamera?
Allows magnification of the view
Why do we perform arthroscopy?
Visualize the joint, magnification and fluid medium
Arthroscopy is routine treatment for joint diseases in _____ and _____.
dogs, horses
What are 4 benefits to using arthroscopy vs. arthrotomy?
- Less isruption of periarticular tissue
- Earlier return to normal function
- Can operate multiple joints at a time
- Better cosmetic outcome
What is the most common size scope used in horses?
4.0 mm
What is the most common size scope used in dogs?
2.7 mm
What angle is favored by arthroscopists?
20-30 degrees
What are cannulas used for?
Allow the arthroscope to be inserted into the joint, protects it from bending or breaking
What instruments are used for arthroscopy?
Probe, curettes, grasping forceps
Why do we use fluids during arthroscopy?
Pressure controls hemorrhage
Flattens synovial membrane and distends joints to provide greater visualization
Removes debris
Why do we induce a pneumoperitoneum and what gases can be used?
Distends area so you can see;
CO2, air, oxygen, N2O, argon, helium, mixtures
Why is CO2 the best choice for insufflation?
- High diffusion coefficient
- Normal metabolic end product
- Rapidly cleared
- Highly soluble in blood and tissues
- Does not support combustion
- Risk of gas embolism low
What gas is preferred in patients with cardiac disease and why?
N2O due to possible induced hypercarbia with CO2
What pressure is safe for pneumoperitoneum?
15 mm Hg or less
What diameter vessel can Ligasure be used on?
7mm or less
What procedures can be done laparoscopically?
Biopsy, hernia repair, closure of nephrosplenic space/epiploic foramen, cryptorchid neuter, ovariectomy, gastropexy, abomasopexy
What instruments can be inserted into an endoscope through the biopsy channel?
Biopsy forceps, baskets for FB retrieval, laser for tissue resection and cautery
What orthopedic procedure can be done with MIS?
Fracture repair
What is a da Vinci system?
Surgical robot with 3-4 arms that are inserted through incisions;
One arm is a camera and 2 act as the surgeon’s hands
Optional 4th arm moves things out of the way
What is an advantage to using a da Vinci rather than doing the surgery manually?
Robot can make tiny, precise movements - eliminates microtremors from human hands
What are disadvantages to robotic surgery?
Training, time, cost of unit, cost to patient, size
