Lecture 26: Principles of Minimally Invasive Surgery (Exam 3) Flashcards
What is the goal of minimally invasive surgery
- Brief overview
- Endoscopic techniques
- principles & description of equipment
Define endoscopy
Use of an instrument (endoscope) to visualize interior of organ or body cavity that cannot be examined w/o surgery
Define flexible endoscopy
Endoscope that bends to look &/or move around corners (ability to make bends greater than 180 degrees for most scopes)
What are the components of a flexible endoscope & what are they used for
- 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
What do immersible scopes have
Handles placed in water w/out risk of damage
Label the following
Define a rigid endoscopy
Plastic or metal scope that can’t bend
What are the parts of a rigid endocscope & what to they do
- 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
How is rigid endoscopy inserted into the body
- Into the body through skin & soft tissue or a natural orifice
Define portals
Insertion through the skin
What are the two types of portals
- scope inserted through scope or camera portal
- Power & hand tolls inserted through instrument portal
What are cannulas
Metal tubes that maintain portals & protect instruments
What is triangulation
Visualization of instruments through scope to perform biopsies or therapeutic procedures w/in the body cavity
Define gastroduodenoscopy
Endoscopy of esophagus, stomach, & duodenum (occasionally upper jejunum)
Define colonoscopy
Endoscopy of the colon
Define Ileoscopy
Endoscopy of ileum (performed w/ colonoscopy)
Define Proctoscopy
Examination of the anus & rectum
Define bronchoscopy
Endoscopy of the trachea & bronchi
Define Laryngoscopy
Examination of pharynx & larynx
Define rhinoscopy
Endoscopy of the anterior nares & examining nasal passages (may include examination of the choanae)
Define Cystoscopy
- Endoscopy of the urinary bladder
- Can be a retrograde or a transabdominal cystoscopy
What is the diff btw/ an retrograde and a transabdominal cystoscopy
- 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
Define a vaginoscopy
Endoscopy of the vagina
What is a laparoscopy
- 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)
What is a thoracoscopy
*Endoscopy of a pleural cavity
* Same dx or intervention as a laparoscopy
What is an arthroscopy
Endoscopy of a joint
Describe arthroscopes
- Always used through cannulas
- Other instruments & fluid outflow devices are used w/ or w/out cannulas
What is instrumenting
Insertion of an endoscope, arthroscope, or other instrument into the joint
What is triangulation
Visualization of instruments through scope to perform biopsies or therapeutic procedures in a joint
How is a scope inserted for a arthroscopy
Through a scope or camera portal
How are power tools inserted in an arthroscopy
Inserted through an instrument portal
What does inflow or ingress mean
Fluid glowing into the joint
What does outflow or egress
Fluid glowing out of the joint
What is a second-look arthroscopy
Repeat arthroscopy of a joint that was prev scoped
What can be procedures can be done w/ endoscopy
- Biopsy organs
- Remove foreign objects
- Examine the inside of hollow organs
What is true about an endoscopy
- Only valuable when successful
- Eliminates the need for more invasive sx
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
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
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
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
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
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
Indications of cystoscopy
- Dx of ectopic ureters
- Biopsy proliferative lesions in urethra & bladder (esp carcinomas)
- Injection of collagen in urethra for incontinence
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)
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
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
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
What are the indications of Laparoscopy
- Exam & bx of abdominal viscera
- Determine if celiotomy indicated
- Minimally invasive interventional sx
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
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
Where can the rigid endoscopes be used
- Esophagus
- Descending colon
- Larynx
- Nose
- Trachea
- Peritoneal, pleural, & joint spaces
Label the following
Label the following retrieval forceps used for FBs
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
Label the following rigid biopsy forceps
- Top: Clamshell or double spoon forceps
- Bottom: Shearing scissor like cut
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)
What are the 4 basic principles to most endoscopic procedures
- Advance the scope only if you can see where you are going
- 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)
- Aim the scope toward the center of the lumen (unless looking @ specific lesions)
- Do not insert the endoscope into a px any harder than you would want a physician to insert it into you!
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
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
What is the most common arthroscopically performed procedure
Fragment removal (OCD & FCP)
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
What is the most significant diagnostic advantage of arthroscopy
- Ability to assess condition of the cartilage surface
What are some common dxes w/ arthroscopy shoulder
- OCD
- OA
- Biceps disease
- MCL tearing
- LCL tearing
Label the normal shoulder joint in arthroscopic view:
What are some common dxes w/ arthroscopy elbow
- FCP
- OCD
- UAP
- IOHC
Label the following arthroscopy of the elbow joint:
What are some common dxes w/ arthroscopy carpus
- OA
- Chip fractures
What are some common dxes w/ arthroscopy hip
- OA
- Labral tearing & avulsion
- Tearing of ligament of femoral head
- Neoplasia
What are some common dxes w/ arthroscopy Stifle
- OCD
- Cruciate disease/damage
- OA
- Meniscal disease/damage
What are some common dxes w/ arthroscopy tarsus
- OCD
- Chip fractures
What are some common arthroscopic shoulder procedures
- Fragment removal - OCD
- Osteoarthritis tx (microfracture & abrasion)
- Biceps tenotomy
- Soft tissue shrinkage for instability (no longer done)
What are some common arthroscopic elbow procedures
- Fragment removal (OCD & FCP)
- Osteoarthritis tx (microfracture & abrasions)
What are some common arthroscopic carpus procedures
- Fragment removal (chip fractures)
- Osteoarthritis tx (microfracture & abrasion)
What are some common arthroscopic hip procedures
- OA assessment
- Biopsy
What are some common arthroscopic stifle procedures
- Fragment removal
- OA tx
- Meniscal tear tx
- Cruciate ligament debridement
What are some common arthroscopic tarsus procedures
- Fragment removal
- OA tx
Label the following hand instruments:
What should you know as a beginning arthroscopist
- You may not be able to successfully removal all fragments
- Be prepared to perform an arthrotomy
