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Surgery 1 > Lecture 26: Principles of Minimally Invasive Surgery (Exam 3) > Flashcards

Lecture 26: Principles of Minimally Invasive Surgery (Exam 3) Flashcards

1
Q

What is the goal of minimally invasive surgery

A
  • Brief overview
  • Endoscopic techniques
  • principles & description of equipment
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2
Q

Define endoscopy

A

Use of an instrument (endoscope) to visualize interior of organ or body cavity that cannot be examined w/o surgery

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3
Q

Define flexible endoscopy

A

Endoscope that bends to look &/or move around corners (ability to make bends greater than 180 degrees for most scopes)

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4
Q

What are the components of a flexible endoscope & what are they used for

A
  • Handle - where scope is held by the operator
  • Insertion tube - part inserted into px
  • Umbilical cord - Part attaches scope to light source & video processor
  • Biopsy channel - allows instrument placement through scope
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5
Q

What do immersible scopes have

A

Handles placed in water w/out risk of damage

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6
Q

Label the following

A
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7
Q

Define a rigid endoscopy

A

Plastic or metal scope that can’t bend

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8
Q

What are the parts of a rigid endocscope & what to they do

A
  • Lens - @ the scope tip to allow looking @ various angles even-180 degrees backwards
  • Obturator - Device placed through hollow endoscopy to facilitate insertion of scope into organ
  • Trocar - Obturator w/ sharp point to facilitate penetration through tissue
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9
Q

How is rigid endoscopy inserted into the body

A
  • Into the body through skin & soft tissue or a natural orifice
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10
Q

Define portals

A

Insertion through the skin

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11
Q

What are the two types of portals

A
  • scope inserted through scope or camera portal
  • Power & hand tolls inserted through instrument portal
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12
Q

What are cannulas

A

Metal tubes that maintain portals & protect instruments

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13
Q

What is triangulation

A

Visualization of instruments through scope to perform biopsies or therapeutic procedures w/in the body cavity

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14
Q

Define gastroduodenoscopy

A

Endoscopy of esophagus, stomach, & duodenum (occasionally upper jejunum)

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15
Q

Define colonoscopy

A

Endoscopy of the colon

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16
Q

Define Ileoscopy

A

Endoscopy of ileum (performed w/ colonoscopy)

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17
Q

Define Proctoscopy

A

Examination of the anus & rectum

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18
Q

Define bronchoscopy

A

Endoscopy of the trachea & bronchi

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19
Q

Define Laryngoscopy

A

Examination of pharynx & larynx

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20
Q

Define rhinoscopy

A

Endoscopy of the anterior nares & examining nasal passages (may include examination of the choanae)

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21
Q

Define Cystoscopy

A
  • Endoscopy of the urinary bladder
  • Can be a retrograde or a transabdominal cystoscopy
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22
Q

What is the diff btw/ an retrograde and a transabdominal cystoscopy

A
  • Retrograde is advancing the scope through the urethra & into the bladder
  • Transabdominal is placing a scope thru cannula thru the abdominal wall & the bladder wall
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23
Q

Define a vaginoscopy

A

Endoscopy of the vagina

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24
Q

What is a laparoscopy

A
  • Endoscopy of the peritoneal cavity
  • Can be used for dx (concerned w/ biopsy of organ)
  • Interventional - to perform min invasive sx (like gastropexy or jejunostomy tube placement)
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25
Q

What is a thoracoscopy

A

*Endoscopy of a pleural cavity
* Same dx or intervention as a laparoscopy

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26
Q

What is an arthroscopy

A

Endoscopy of a joint

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27
Q

Describe arthroscopes

A
  • Always used through cannulas
  • Other instruments & fluid outflow devices are used w/ or w/out cannulas
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28
Q

What is instrumenting

A

Insertion of an endoscope, arthroscope, or other instrument into the joint

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29
Q

What is triangulation

A

Visualization of instruments through scope to perform biopsies or therapeutic procedures in a joint

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30
Q

How is a scope inserted for a arthroscopy

A

Through a scope or camera portal

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31
Q

How are power tools inserted in an arthroscopy

A

Inserted through an instrument portal

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32
Q

What does inflow or ingress mean

A

Fluid glowing into the joint

33
Q

What does outflow or egress

A

Fluid glowing out of the joint

34
Q

What is a second-look arthroscopy

A

Repeat arthroscopy of a joint that was prev scoped

35
Q

What can be procedures can be done w/ endoscopy

A
  • Biopsy organs
  • Remove foreign objects
  • Examine the inside of hollow organs
36
Q

What is true about an endoscopy

A
  • Only valuable when successful
  • Eliminates the need for more invasive sx
37
Q

When is endoscopy not useful

A
  • If tissue samples are inadequate for dx
  • Unacceptable trauma occurs during endoscopic removal of foreign objects
  • Mucosal surfaces can’t be adequately examined
38
Q

When should px be referred for this procedure

A

If the doctor is not sufficiently trained or not performing this procedure often enough to maintain expertise

39
Q

What are the indications of a gastroduodenoscopy

A
  • Gastric & intestional biopsy/cytology for dx of infiltrative & lymphatic disorders
  • ID of mass, ulceration, erosion, lymphagiectasia, or physaloptera infestation
  • Placement of G-tube
  • Location of lesions before/during sx
  • Removal of gastric polyps w/ clinical sx
40
Q

What are the indications of an esophagoscopy

A
  • ID & removal of foreign objects
  • Dx & Dilation of strictures
  • Aid in stent placement
  • Dx of esophagitis
  • Biopsy of tumors
41
Q

What are the indications of a proctoscopy & colonoileoscopy

A
  • Biopsy of colon, rectum, ileum, or cecum for infiltrative disorders
  • ID of occult whipworm infestation
  • Dx/removal of polyps
  • Dx of cecocolic intussusception
42
Q

What are the indications of a laryngoscopy

A
  • ID of laryngeal paralysis
  • ID of elongated soft palate &/or everted laryngeal saccules
  • Location & removal of FBs
  • Bx mass or other infiltrative lesions
43
Q

Indications of cystoscopy

A
  • Dx of ectopic ureters
  • Biopsy proliferative lesions in urethra & bladder (esp carcinomas)
  • Injection of collagen in urethra for incontinence
44
Q

Indications of a thoracoscopy

A
  • ID/bx of masses & other infiltrative lesions (lung bx)
  • Placing chest tubes in animals w/ pyothorax
  • Determine if thoracotomy is indicated (and the best open approach)
  • Performance of min invasive sx (pericardiectomy & ligation/resection of PRAA)
45
Q

Indications of Bronchoscopy

A
  • ID of lesions (collapsed trachea or oslerus osleri infestation)
  • Bronchoalveolar lavage or brushing of trachea/bronchus for cytology/culture
  • ID & removal of FBs
  • ID of lung lobe torsion
  • Biopsy of mucosa (chronic bronchitis
  • Placement of stents/evaluation of stents previously place
46
Q

What are the indications of rhinoscopy

A
  • ID & removal of foreign objects
  • Biopsy/cytology of mass lesions & mucosa for infiltrative disorders
  • ID & bx of aspergillomas
  • ID of source of epistaxis or chronic nasal discharge
47
Q

What are the indications of a posterior nares (choanal) exam

A
  • ID & removal of FBs
  • Cytology/culture of the caudal nares
  • ID of & bx of proliferative disorders
  • ID, dilation, & stenting of nasopharyngeal stenosis
  • ID of nasal mites
48
Q

What are the indications of Laparoscopy

A
  • Exam & bx of abdominal viscera
  • Determine if celiotomy indicated
  • Minimally invasive interventional sx
49
Q

What are the indications of arthroscopy

A
  • ID & bx of lesions
  • Removal of loose bodies
  • Topical management of osteoarthritis
  • Joint lavage for sepsis
  • Arthroscopic assisted fracture repair
  • Arthroscopic assisted joint stabilization
50
Q

Compare flexible & rigid endoscopes

A
  • Flexible: Greater access to more sites in viscous organs, more expensive than rigid scopes, easier to damage/requires training to assemble & clean w/o damaging, & req substantial training to use properly
  • Rigid: Less expensive than flexible scopes, usually more durable, easier to learn to use, & capable of larger bxs than w/ flexible scopes, excellent for simultaneous removal of foreign objects & protecting mucosa
51
Q

Where can the rigid endoscopes be used

A
  • Esophagus
  • Descending colon
  • Larynx
  • Nose
  • Trachea
  • Peritoneal, pleural, & joint spaces
52
Q

Label the following

53
Q

Label the following retrieval forceps used for FBs

54
Q

Describe the four-wire baskets

A
  • Top: Work well due to great flexibility of wires
  • Bottom: Doesn’t open as wide & the wires are firm which make it difficult to ensnare FBs
55
Q

Label the following rigid biopsy forceps

A
  • Top: Clamshell or double spoon forceps
  • Bottom: Shearing scissor like cut
56
Q

What are some rules for endoscope care

A
  • Always use a mouth gag
  • Never introduce an insertion tube into the mouth of an unanesthetized animal
  • Review manufacturer’s recommendations
  • Never subject flexible scopes to heat (esp autoclaving)
57
Q

What are the 4 basic principles to most endoscopic procedures

A
  1. Advance the scope only if you can see where you are going
  2. If you cannot see what is happening back the scope out a little or insufflate a little air/infuse some fluid into the lumen (or do both)
  3. Aim the scope toward the center of the lumen (unless looking @ specific lesions)
  4. Do not insert the endoscope into a px any harder than you would want a physician to insert it into you!
58
Q

What are the advantages of endoscopic removal of foreign objects

A
  • Faster than sx
  • Less stressful to px
  • Reduced tissue trauma, morbidity, & recovery time
  • Reduced cost to client
59
Q

What are the disadvantages of endoscopic removal of foreign objects

A
  • Can’t remove all objects
  • Can hurt the px w/ careless tech
  • Req assortment of expensive FB retrieval devices
60
Q

What is the most common arthroscopically performed procedure

A

Fragment removal (OCD & FCP)

61
Q

Why is arthroscopy superior to radiography in the dx of joint disease

A
  • Allows direct visualization of cartilage & soft tissue structure
  • Provides magnification
  • Enable biopsy of virtually all structures w/in the joint
62
Q

What is the most significant diagnostic advantage of arthroscopy

A
  • Ability to assess condition of the cartilage surface
63
Q

What are some common dxes w/ arthroscopy shoulder

A
  • OCD
  • OA
  • Biceps disease
  • MCL tearing
  • LCL tearing
64
Q

Label the normal shoulder joint in arthroscopic view:

65
Q

What are some common dxes w/ arthroscopy elbow

A
  • FCP
  • OCD
  • UAP
  • IOHC
66
Q

Label the following arthroscopy of the elbow joint:

67
Q

What are some common dxes w/ arthroscopy carpus

A
  • OA
  • Chip fractures
68
Q

What are some common dxes w/ arthroscopy hip

A
  • OA
  • Labral tearing & avulsion
  • Tearing of ligament of femoral head
  • Neoplasia
69
Q

What are some common dxes w/ arthroscopy Stifle

A
  • OCD
  • Cruciate disease/damage
  • OA
  • Meniscal disease/damage
70
Q

What are some common dxes w/ arthroscopy tarsus

A
  • OCD
  • Chip fractures
71
Q

What are some common arthroscopic shoulder procedures

A
  • Fragment removal - OCD
  • Osteoarthritis tx (microfracture & abrasion)
  • Biceps tenotomy
  • Soft tissue shrinkage for instability (no longer done)
72
Q

What are some common arthroscopic elbow procedures

A
  • Fragment removal (OCD & FCP)
  • Osteoarthritis tx (microfracture & abrasions)
73
Q

What are some common arthroscopic carpus procedures

A
  • Fragment removal (chip fractures)
  • Osteoarthritis tx (microfracture & abrasion)
74
Q

What are some common arthroscopic hip procedures

A
  • OA assessment
  • Biopsy
75
Q

What are some common arthroscopic stifle procedures

A
  • Fragment removal
  • OA tx
  • Meniscal tear tx
  • Cruciate ligament debridement
76
Q

What are some common arthroscopic tarsus procedures

A
  • Fragment removal
  • OA tx
77
Q

Label the following hand instruments:

78
Q

What should you know as a beginning arthroscopist

A
  • You may not be able to successfully removal all fragments
  • Be prepared to perform an arthrotomy

Surgery 1 (25 decks)

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