Minimally invasive surgery Flashcards

1
Q

Name 4 actions involved in surgical procedures

A
  • Incising
  • Excising (removing)
  • Repairing/reconstruct
  • Replace:
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2
Q

Name 3 things that occur after an incision.

A
o	Pain
o	Deformity/cosmesis
o	Recovery period
   	Loss of function
   	Immobilization
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3
Q

Name 4 advantages of laparoscopy (video-guided surgery)

A

o Provides light
o Magnification
o Eye near target
• Avoids large incision

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4
Q

What is the promise of MIS?

A
  • Less pain
  • Invisible scar (Virtually no scarring (visible and invisible))
  • Quick recovery
  • No significant weight loss or weakness
  • Minimal loss of work and income
  • Quick return to “pleasurable” activities
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5
Q

What does a patient want from surgery ?

A
  • Relief of pain
  • Able to eat
  • Cure of issue
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6
Q

Name 3 challenges of MIS

A

• 2D (monocular image) – diminished depth perception

• Long instruments (can be 2-3x more than chopsticks)
o Decreased tactile sensation
o Amplifies tremor

• Work through port (trocar) – 2.8-15mm diameter
o Limited range of motion
o Lever effect (if you want to move instrument upwards, you need to move downwards)
Abdomen filled with gas; we don’t want gas to escape, so hard to move instruments

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7
Q

Why did MIS show important issues at the onset of its implementation?

A

People were not trained properly to use it.

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8
Q

Name the 3 steps of the apprenticeship model

A
  • See one
  • Do one
  • Teach one
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9
Q

What are the issues with research assessing outcomes of MIS?

A
•	Learning Curve
•	Challenges with randomization
o	Hard to tell people that they will either have 3 small scars or a 5-inch incision…
•	Challenges of blinding
o	Easy to know what they got
•	Patient’s expectations and bias
o	Some patients where laparoscopic intervention was planned but had to be switched to open operation --> Quicker recovery than those whose original plan was open. 
•	Surgeon’s bias
•	Nurses’ bias
•	Anesthesia bias
•	Perioperative Orders
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10
Q

Which is better to learn laparoscopy to surgeons? Usual training or simulator training ?

A

• Trained group improved substantially in simulator (from 40 to 95)
o would pass FLS test
• Non-trained group improved slightly (38 to 60)
o would not pass FLS test
• Non-trained group had minimal improvement in OR (from 12.4 to 14.3)
• Trained group improved substantially in OR (from 10.8 to 17.2)
o equivalent of 2 years clinical training
o About 6 hours of training  2 year level!

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11
Q

What are the advantages of robotic-assisted surgery as opposed to MIS?

A
  • No need of gloves, PPE
  • Robotic instruments have more range of movement inside the patient, adds a degree of dexterity (wristed)
  • Surgery can be performed remotely
  • Skill level required lower (learning curve shorter)
  • Imagery of the robot is binocular (3-dimensional) = enhanced depth perception
  • Some filters can be entered in the robot to remove tremor, for example.
  • Cosmetic outcomes same as laparoscopic
  • Ergonomic benefit for surgeons
  • Shorter LOS
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12
Q

What are the disadvantages of robotic-assisted surgery as opposed to MIS?

A
  • Depends on bandwidth of connection, reliability of connection, speed of light (fiberoptic networks – longer distance = longer delay)
  • Cost (~5 million $ for one robot, annual service plan 250,000$)
  • No tactile sensation
  • Minilaparoscopy not possible (ports > 7mm)
  • Size of robot = room space needed
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13
Q

What are the advantages of robotic surgery over open surgery in prostate cancer?

A

• Compared to open surgery: robotic-surgery reduced blood loss, pain and recovery time
• Longer term outcomes are equivalent.
o after 12 months, there is no major difference between the two for urinary control and sexual function (in prostate cancer).
o The cancer outcomes are the same (in prostate cancer)

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14
Q

What do meta-analyses show in terms of preference for robotic surgery or MIS?

A
  • Robotic platforms are very expensive and result in longer operative duration than laparoscopy, but with no obvious difference versus open surgery in terms of the quality of evidence and outcomes.
  • Conclusion “there is currently no clear advantage with existing robotic platforms with refinement, competition, and cost reduction, future versions have the potential to improve clinical outcomes without the existing disadvantages.”
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