Minimally invasive/ General surgery Test 2 Flashcards
What is a minimally invasive surgery?
treatment of pathologies while causing as little trauma to the patient as possible
What are some advantages to minimally invasive surgeries?
reduce pain
reduce scarring
shorter procedure times
less infection potential
faster recovery
-accessing areas otherwise unsafe to operate on
What are some disadvantages of minimally invasive surgeries?
-not everyone is a candidate
-complex and expensive
-exposure and working space
-has potential to convert to an open case
Define endoscopy
broad term referring to looking inside the body with a scope
What cavity is a colonoscopy?
colon cavity
What cavity is the laparoscopy?
abdominal cavity
What cavity is the thoracoscopy?
thoracic cavity
Describe a rigid endoscope
metal scope
5MM or 10MM
0,30,45,70 degree
Describe a flexible endoscope
bends and snakes through the system aka flexible
What are the attachments to the endoscope?
-camera head- ability to zoom and focus
-light cord- fiberoptic and loosely coiled
What are parts to the camera head?
coupler connects camera to scope
focus and zoom buttons
white balancing button
What is fluid distension?
fluid pumped into organ to create distension
ex-bladder, uterus, joints
What is gas distension?
Insufflation: CO2 pumped into body cavity to create distension
ex-pneumoperitoneum- abdomen
Veress needle used
Advantages of robotic surgery
-provides movement but with improved range of motion
-eliminates tremors of hands
-complex and precise movement
-3-D view
-theoretically can perform surgery from different locations
Disadvantages of robotic surgery
-Expensive
-Equipment has limited # of uses
-potential to convert to open
-learning curve for all
What are the 2 DaVinci systems at Reading?
XI- in 3 rooms
X- in 1 room
What are the 3 components of the DaVinci robot?
-Surgeon console: 3D image, control station, non-sterile
-Patient cart: where arms are connected
-Vision cart: image processing system, fiberoptic light system, mono and bipolar cautery generator
What are robotic EndoWrists?
exchangeable instruments
grasping, needle drivers, retractors, hemostatic clips
(saves position during instrument exchanges)
What are the robotic scopes and trocars?
scope 8mm0 and 8mm30
Trocars- 3-4 placed, 8 or 12mm, remote center- depth of perception
What are some specific things to have on your table setup?
Cutdown
lap set
endowrist set
scope
trocar
drapes Patient and robot
What are 2 things to never do during robot case?
-move robot when its docked to the patient
-adjust the bed when robot is docked
What is the alimentary system and what is the pathway?
Gi tract- the entire path that food travels through the body
esophagus
stomach
small/ large intestines
appendix
rectum/ anus
What are the abdominopelvic quadrants?
right upper
left upper
right lower
left lower
What are the abdominopelvic regions?
right hypochondriac
epigastric
left hypochondriac
right lumbar
umbilical
left lumbar
right iliac
hypogastric
left iliac
What organs are in the right hypochondriac region?
liver
gallbladder
right kidney
small intestine
What organs are in the epigastric region?
stomach
liver
pancreas
duodenum
spleen
adrenal glands
What organs are in the left hypochondriac region?
spleen
colon
left kidney
pancreas
What organs are in the right lumbar?
gallbladder
liver
right ascending colon
What organs are in the umbilical region?
umbilicus
some small intestine
duodenum
What organs are in the right iliac region?
appendix
cecum
What organs are in the hypogastric region?
urinary bladder
sigmoid colon
reproductive organs
What organs are in the left iliac region?
descending colon
sigmoid colon
Is the abdominal cavity sterile?
yes
What is the peritoneum in the peritoneal cavity?
a serous membrane lining the walls and organs of the abdomen
The peritoneal cavity includes what intraperitoneal organs?
digestive system
lymphatic system
vessels
adipose tissue
What is the first section of the alimentary canal?
mouth
Oropharynx: back of tongue, tonsils, and throat
After the mouth, what is the next section of the alimentary system?
Esophagus including the lower esophageal sphincter
After the esophagus, what is the next section of the alimentary canal and its parts?
Stomach: cardia, fundus, greater/lesser curvatures, Pylorus “funnel”, pyloric sphincter, rugae (folds on inside)
* what are the 3 things inside the stomach aiding in digestion?*
Gastrin- hormone stimulating stomach to make acid
hydrochloric acid- breaks down and kills bacteria
pepsinogen- enzyme for protein digestion
After the stomach, what is the next section of the alimentary canal and its parts?
small intestine (majority of nutrient absorption)
duodenum- shortest section
jejunum
ileum
~22 feet long
After the small intestine, what is the next section of the alimentary canal and its parts?
Large intestine/ colon (fluid absorption)
ileocecal valve
cecum/ appendix
ascending colon
transverse colon
descending colon
sigmoid colon
What are the corners of the large intestine called?
right and left colic flexures
What is the name of the right flexure and what it near?
Hepatic- liver
What is the name of the left flexure and what is it near?
splenic- spleen
After the large intestine, what is the next section of the alimentary canal?
rectum
anus
What is the mesentery?
under layer
connects small and large intestines
blood supply
structural support- no twisting
lymph activity
What is the omentum?
Outer fatty layer to protect organs- like a drape
on top of mesentary
What are the 5 layers of the GI tract?
Serosa
Muscularis
Submucosa
mucosa
Villi (small intestine)
(SMSMV)
What is the serosa layer of the Gi tract?
outer layer- protection, serous lubricant
What is the muscularis layer of the GI tract?
muscular layer- contraction/relaxation
peristalsis- wavy movement of food
What is the submucosa layer of the GI tract?
intermediate layer- connective, blood supply, glandular
What is the mucosa layer of the GI tract?
inner layer (deepest)- absorption and secretion
What are the villi and where are they located in the GI tract?
finger like hairs for absorption
small intestine only
What is in the biliary tract of the digestive system?
creation, storage, and transport of bile
What organs make up the biliary tract?
pancreas- secrets hormones
liver- makes bile
gallbladder- storage
What is the biliary duct system?
tubes connecting gallbladder, liver, and pancreas.
delivers bile and digestive juices to duodenum
What are the 6 “ducts” of the biliary tract?
cystic duct
hepatic duct
common bile duct
pancreatic duct
ampulla of Vater
Sphincter of Oddi
What organ does the cystic duct go into?
gallbladder
What organ does the hepatic duct go into?
liver
The common bile duct connects what two organs/ducts?
cystic and hepatic (gallbladder and liver)
Where is the pancreatic duct located?
in the pancreas
What does the ampulla of Vater do?
joins the pancreatic duct and the common bile duct
What is the sphincter of Oddi?
located at the ampulla of Vector
controls bile excretion into the duodenum
What is the falciform ligament?
fibrous ligament diving right and left lobes of the liver
connects liver to anterior abdominal wall
What are the layers of the abdominal tissues? (hint there 6)
skin
subcuticular
subcutaneous fat
muscle
fascia- (holds organs)
peritoneum (lining of interior walls)
What are the muscle layers of the abdominal wall?
internal and external oblique
rectus abdominus “6 pack”
transversus abdominus
What is the fascia layer of the abdominal tissues?
tough fibrous connective tissue (allows muscles to move)
What is the Linea alba layer of the abdominal tissues?
white
fibrous tissue running down midline from xyphoid to pubis
connects rectus muscles
What is the Linea Semilunaris layer of the abdominal tissues?
lateral fascial border of rectus muscles
(right and left side)
What is the difference between the visceral and parietal peritoneum?
visceral- inner layer closer to organ
parietal- outer layer closer to the wall
What is the simplest abdominal incision? What organs can be gotten to?
median/ midline vertical incision
Upper- stomach, duodenum, pancreas
lower- uterus, bladder, lower intestine
Where is the paramedian rectus incision located? What organs can be exposed with each incision?
Lateral to the midline
right upper- stomach, duodenum, pancreas
right lower- pelvic structures, proximal colon
left upper- spleen, stomach
left lower- pelvic structures, distal colon
Where is the McBurney oblique incision?
right lower quadrant at 45 degree angle
splits external & internal oblique and transversalis muscles
used for appendectomy
Where is the subcostal oblique incision located? what organs are exposed when incised?
left and right side starts at midline between xiphoid & umbilicus
extends laterally to below the rib cage
right- gallbladder & biliary system
left- spleen
Where is the lower oblique inguinal incision?
Lower then McBurneys incision
right or left side
Inguinal hernia repair
Where is the thoracoabdominal incision made?
patient in lateral position
left or right side
provides access to thoracic and abdominal cavity
Where is the midabdominal transverse incision located?
right or left side
umbilicus to lateral
stomach, pancreas, biliary system
not as common
In what order to wound closures occur? (same as incision or reverse)
reverse order of incision
What are the 3 layers of closing skin for a laparotomies? By
deep fascial layer- majority of wound support (1 or 0 PDS; 1 or 0 Vicryl)
Subcutaneous layer- closing fatty dead space or muscle (3-0 Vicryl)
skin- staples ; 4-0 Monocryl
What is an anoscopy?
examination of mucous of the anal canal
What is a choledochoscopy?
exam of common bile duct
What is a colonoscopy?
exam entire colon from anus to ileocecal valve
(may obtain tissue specimens or remove polyps)
What is an esophagoscopy?
exam of the esophagus
What is a gastroscopy?
exam of gullet, stomach and duodenum
What is an egd?
esophagogastroduodenoscopy
exam of esophagus, stomach, and duodenum
What is an ERCP?
endoscopic retrograde cholangiopancreatography
scope goes down mouth to duodenum
catheter passed into biliary ducts for x-ray of ducts
obstructions removed
What is a proctoscopy?
exam of the mucosa of rectum and anal canal
What is a sigmoidoscopy?
exam of sigmoid and rectum
remove polyps/ tissue specimens
What is a laparoscopy?
exam abdominal cavitiy
trocars placed
instruments through trocars
diagnostic or treatment
What is pneumoperitoneum?
insufflation/ gas in the body
CO2 introduced into abdomen
provide visualization and working room
What is a hernia?
protrusion of organ through a defect
usually in a sac
contents of sac may be abdominal or pelvic viscera or mesentery
What are the different types of hernias?
congenital
traumatic
acquired
What is a congenital hernia?
a hernia formed at birth
What is an acquired hernia?
a hernia that forms at anytime