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Surgery 1 (SAB) > 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
What is a thoracoscopy
*Endoscopy of a pleural cavity * Same dx or intervention as a laparoscopy
26
What is an arthroscopy
Endoscopy of a joint
27
Describe arthroscopes
* Always used through cannulas * Other instruments & fluid outflow devices are used w/ or w/out cannulas
28
What is instrumenting
Insertion of an endoscope, arthroscope, or other instrument into the joint
29
What is triangulation
Visualization of instruments through scope to perform biopsies or therapeutic procedures in a joint
30
How is a scope inserted for a arthroscopy
Through a scope or camera portal
31
How are power tools inserted in an arthroscopy
Inserted through an instrument portal
32
What does inflow or ingress mean
Fluid glowing into the joint
33
What does outflow or egress
Fluid glowing out of the joint
34
What is a second-look arthroscopy
Repeat arthroscopy of a joint that was prev scoped
35
What can be procedures can be done w/ endoscopy
* Biopsy organs * Remove foreign objects * Examine the inside of hollow organs
36
What is true about an endoscopy
* Only valuable when successful * Eliminates the need for more invasive sx
37
When is endoscopy not useful
* If tissue samples are inadequate for dx * Unacceptable trauma occurs during endoscopic removal of foreign objects * Mucosal surfaces can't be adequately examined
38
When should px be referred for this procedure
If the doctor is not sufficiently trained or not performing this procedure often enough to maintain expertise
39
What are the indications of a gastroduodenoscopy
* 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
What are the indications of an esophagoscopy
* ID & removal of foreign objects * Dx & Dilation of strictures * Aid in stent placement * Dx of esophagitis * Biopsy of tumors
41
What are the indications of a proctoscopy & colonoileoscopy
* Biopsy of colon, rectum, ileum, or cecum for infiltrative disorders * ID of occult whipworm infestation * Dx/removal of polyps * Dx of cecocolic intussusception
42
What are the indications of a laryngoscopy
* ID of laryngeal paralysis * ID of elongated soft palate &/or everted laryngeal saccules * Location & removal of FBs * Bx mass or other infiltrative lesions
43
Indications of cystoscopy
* Dx of ectopic ureters * Biopsy proliferative lesions in urethra & bladder (esp carcinomas) * Injection of collagen in urethra for incontinence
44
Indications of a thoracoscopy
* 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
Indications of Bronchoscopy
* 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
What are the indications of rhinoscopy
* 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
What are the indications of a posterior nares (choanal) exam
* 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
What are the indications of Laparoscopy
* Exam & bx of abdominal viscera * Determine if celiotomy indicated * Minimally invasive interventional sx
49
What are the indications of arthroscopy
* 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
Compare flexible & rigid endoscopes
* 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
Where can the rigid endoscopes be used
* Esophagus * Descending colon * Larynx * Nose * Trachea * Peritoneal, pleural, & joint spaces
52
Label the following
53
Label the following retrieval forceps used for FBs
54
Describe the four-wire baskets
* 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
Label the following rigid biopsy forceps
* Top: Clamshell or double spoon forceps * Bottom: Shearing scissor like cut
56
What are some rules for endoscope care
* 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
What are the 4 basic principles to most endoscopic procedures
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
What are the advantages of endoscopic removal of foreign objects
* Faster than sx * Less stressful to px * Reduced tissue trauma, morbidity, & recovery time * Reduced cost to client
59
What are the disadvantages of endoscopic removal of foreign objects
* Can't remove all objects * Can hurt the px w/ careless tech * Req assortment of expensive FB retrieval devices
60
What is the most common arthroscopically performed procedure
Fragment removal (OCD & FCP)
61
Why is arthroscopy superior to radiography in the dx of joint disease
* Allows direct visualization of cartilage & soft tissue structure * Provides magnification * Enable biopsy of virtually all structures w/in the joint
62
What is the most significant diagnostic advantage of arthroscopy
* Ability to assess condition of the cartilage surface
63
What are some common dxes w/ arthroscopy shoulder
* OCD * OA * Biceps disease * MCL tearing * LCL tearing
64
Label the normal shoulder joint in arthroscopic view:
65
What are some common dxes w/ arthroscopy elbow
* FCP * OCD * UAP * IOHC
66
Label the following arthroscopy of the elbow joint:
67
What are some common dxes w/ arthroscopy carpus
* OA * Chip fractures
68
What are some common dxes w/ arthroscopy hip
* OA * Labral tearing & avulsion * Tearing of ligament of femoral head * Neoplasia
69
What are some common dxes w/ arthroscopy Stifle
* OCD * Cruciate disease/damage * OA * Meniscal disease/damage
70
What are some common dxes w/ arthroscopy tarsus
* OCD * Chip fractures
71
What are some common arthroscopic shoulder procedures
* Fragment removal - OCD * Osteoarthritis tx (microfracture & abrasion) * Biceps tenotomy * Soft tissue shrinkage for instability (no longer done)
72
What are some common arthroscopic elbow procedures
* Fragment removal (OCD & FCP) * Osteoarthritis tx (microfracture & abrasions)
73
What are some common arthroscopic carpus procedures
* Fragment removal (chip fractures) * Osteoarthritis tx (microfracture & abrasion)
74
What are some common arthroscopic hip procedures
* OA assessment * Biopsy
75
What are some common arthroscopic stifle procedures
* Fragment removal * OA tx * Meniscal tear tx * Cruciate ligament debridement
76
What are some common arthroscopic tarsus procedures
* Fragment removal * OA tx
77
Label the following hand instruments:
78
What should you know as a beginning arthroscopist
* You may not be able to successfully removal all fragments * Be prepared to perform an arthrotomy

Surgery 1 (SAB) (25 decks)

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