Minimally Invasive Surgery Flashcards
What aer minimally invasive surgeries?
Use of cameras/microscope to directly visualize organs in question using small incisions to diagnose & treat certain disease entities
What are endoscopic procedures categorized as minimally invasive surgeries?
Cystoscopy: Eval of urinary bladder through the urethra
Choledochoscopy: scope is inserted into the biliary tree or bile duct
Laryngoscopy: examination of the throat
Bronchoscopy: evaluation of the bronchioles using fiber optic equipment
What is done after operation in minimally invasive surgeries?
Px’s wounds are covered with small gauze, bandages, or bandaids
Incisions are small as keyholes
What are the different forms of MIMS?
Laparoscopy = abdominal wall
THoracoscopy = thoracic wall
Robotic surgery
Natural orifice transluminal Endoscopic SUrgery (NOTES) = natural orifices (mouth, vagina, anus)
What is the first NOTES done in a human being?
Appendectomy
WHat is a technological innovation that uses a small & light video camera to explore and treat?
Laparoscopy
What are the disadvantages of laparascopy?
- Equipment-dependent
- Requires thorough knowledge of the equipment and instruments used
- Trouble-shoting abilities are essential
- approach & skills are total different from open approach
- Laparo-skeptic or laparo-enthusiast (old dogs and new dogs)
What are the 4 sites of incision for traditional laparoscopic cholecystectomy?
Umbilicus/belly button -> where camera is inserted
Epigastrium
Right upper quadrant
Right anterior axillary -> same level as umbilicus
What are the 3 sites of incision for Laparoscopic cholecystectomy?
Umbilicus
Epigastrium
RUQ
What are the advantages of 1 or 2 incision sites for Laparoscopic cholecystectomy?
Less incisions, more difficult in the procedure
Single incision laparoscopic surgery
- more complications can occur
- common problem
- can be done
What are the advantages of MIS?
- less postop pain & discomfort
- faster recovery & return to work & daily activities
- less likelihood developing wound infections, incisional hernias & post-op adhesions
- more cosmetically appealing
What are the disadvantages of MIS?
- More difficult to perform
- Problem of haptics (ability to feel structures with long instruments)
- requires additional training to perform
- more expensive bcos of special equipment
- needs general anesthesia in all cases
- ergonomic issue for the surgeon
What are the C/Is to MIS?
- inability to tolerate general anesthesia = give regional anesthesia (epidural or spinal) to use instead
- bleeding disorders
- lack of surgical experience
What are the majority of procedures done in robotic surgery?
Prostate surgery (prostatectomy)
In what parts of the body is robotic surgery advantageou?
Tight spaces: pelvis, neck, thorax, pericardial area
What are the instruments need in Laparoscopic tower?
TV monitor
light source = halogen bulb, Xenon, light emiting diode
Insufflator (CO2)
VCD/DVD recorder
Camera processing unit = CPU
What are diff hand instruments?
Trocars = proportional to # of incisions
Camera scope = Laproscope
Grasping forces/Graspers = handle intra-abdominal organs
Dissectors
SCissors/ENdoshears
Energy devices = Monopolar/bipolar cautery, Ultrasonic device, Vessel sealing device
What are different factors assoc with egonomics?
Body posture
Monitor
Operating table
Foot pedals
Surgical instruments
What is done in Thorascopy?
MIS for the thorax
What is an important features of thoracoscopy?
Bony confines of the thorax makes it unnecessary to use positive pressure when working in the area -> Disadvantages of positive pressure -> DEC venous return, mediastinal shift, need to keep a film seal at all trocar sites
What can be used in thorascoscopy if there’s no positive pressure so that the ipsilateral lung can be deflated when the operation starts?
Double-lumen endotracheal tube
Why do we need to deflat the lungs before thoracocopy?
To easily get through the thorax
What are the 2 access to subcutaneou & extraperitonael surgery?
Balloon dissection
Subcutaneou surgery
Which i sthe one effective for retroperitoneal locations for inguinal hernias, retroperitoneal surgery for adrenalectomy?
Balloon dissection
What is the most widely used MIS in Cardiac, vascular, and plastic surgery?
Subcutaneous surgery
What vein is punctures in subQt surgery?
Saphenou vein
What surgery is done to assist with difficult cases before conversion to celiotomy?
Hand-assisted laparoscopic access
What is hand-assisted laparoscopic access?
Combine the tactile advantages ofopen surgey with the minimal access of laparoscopy & thoracoscopy
What are the diff approaches to natural orifice transluminal endoscopic surgery access?
Transvaginal, transvesical, transanal, transcolonic, transgastric, and transoral approaches
What access uses a single skin incision, multiple low-profile trocars can be placed seaparately
Single-incision laparoscopic surgeru access
What are the advantages & disadvantages?
Advantage: conventional laparoscopic tools employted
Disadvantage: becomes apparent when an extraction site is needed
What is the guideline in placing of trocars in Port placement?
Left and right hand should be placed at least 10cm apart
What type of camera is used in imaging systems?
Charge-couple device
What is the most comon energy source in endoscopic and endoluminal surgery?
Radiofrequency electrosurgery
What areh 2 most common methods of deliverying RF electrocautery?
Monopolar and Bioplar electrosurgery
What is the use of monopolar electrosurgery?
- better for tissue dessication and vaporization
- least amt of themal injury & coagulation necrosis
What is the Argon beam coagulation best for?
Coagulation of diffusely bleeding surfaces
Less value in laparoscopic procdures
Type of MOnopolar electrosurgery
What is the use of Biolar electrosugery?
Best mthd of small-vessel coagulation without theral injury to adjacentt issuses
What are the mechanisms of unrecognized visceral surgery?
- Capacitive coupling = plastic trocar insulates the abdominal wall
- Direct coupling = current is transmitted directly
What is the use of Bipolar electrocoagulation?
Thermal hemostasis
What are the diff lasers used for medical application?
CO2 laser
Neodymiumyttrium-aluminum garnet
Frequency-doubled/KTP laser
Laser tecbology
Ultrasonic energy
What are the diff robotic surgeries?
Laparoscopic camera holder
Master-slave surgical platform
Da Vinci Intuitive Surgical Sunnyvale, CA
Robotic prostatectomy
Female pelvic surgeyr with Da Vicnci robot
Telesurgery
What are the categories of stenting?
Plastic
Metal
Drug-eluting stents
Covered metal
Anchored grafts
Removable covered plastic
