Minimally Invasive Surgery

Question 1

What aer minimally invasive surgeries?

Answer 1

Use of cameras/microscope to directly visualize organs in question using small incisions to diagnose & treat certain disease entities

Question 2

What are endoscopic procedures categorized as minimally invasive surgeries?

Answer 2

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

Question 3

What is done after operation in minimally invasive surgeries?

Answer 3

Px’s wounds are covered with small gauze, bandages, or bandaids

Incisions are small as keyholes

Question 4

What are the different forms of MIMS?

Answer 4

Laparoscopy = abdominal wall
THoracoscopy = thoracic wall
Robotic surgery
Natural orifice transluminal Endoscopic SUrgery (NOTES) = natural orifices (mouth, vagina, anus)

Question 5

What is the first NOTES done in a human being?

Answer 5

Appendectomy

Question 6

WHat is a technological innovation that uses a small & light video camera to explore and treat?

Answer 6

Laparoscopy

Question 7

What are the disadvantages of laparascopy?

Answer 7

• 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)

Question 8

What are the 4 sites of incision for traditional laparoscopic cholecystectomy?

Answer 8

Umbilicus/belly button -> where camera is inserted
Epigastrium
Right upper quadrant
Right anterior axillary -> same level as umbilicus

Question 9

What are the 3 sites of incision for Laparoscopic cholecystectomy?

Answer 9

Umbilicus
Epigastrium
RUQ

Question 10

What are the advantages of 1 or 2 incision sites for Laparoscopic cholecystectomy?

Answer 10

Less incisions, more difficult in the procedure

Single incision laparoscopic surgery
- more complications can occur
- common problem
- can be done

Question 11

What are the advantages of MIS?

Answer 11

• less postop pain & discomfort
• faster recovery & return to work & daily activities
• less likelihood developing wound infections, incisional hernias & post-op adhesions
• more cosmetically appealing

Question 12

What are the disadvantages of MIS?

Answer 12

• 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

Question 13

What are the C/Is to MIS?

Answer 13

• inability to tolerate general anesthesia = give regional anesthesia (epidural or spinal) to use instead
• bleeding disorders
• lack of surgical experience

Question 14

What are the majority of procedures done in robotic surgery?

Answer 14

Prostate surgery (prostatectomy)

Question 15

In what parts of the body is robotic surgery advantageou?

Answer 15

Tight spaces: pelvis, neck, thorax, pericardial area

Question 16

What are the instruments need in Laparoscopic tower?

Answer 16

TV monitor
light source = halogen bulb, Xenon, light emiting diode
Insufflator (CO2)
VCD/DVD recorder
Camera processing unit = CPU

Question 17

What are diff hand instruments?

Answer 17

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

Question 18

What are different factors assoc with egonomics?

Answer 18

Body posture
Monitor
Operating table
Foot pedals
Surgical instruments

Question 19

What is done in Thorascopy?

Answer 19

MIS for the thorax

Question 20

What is an important features of thoracoscopy?

Answer 20

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

Question 21

What can be used in thorascoscopy if there’s no positive pressure so that the ipsilateral lung can be deflated when the operation starts?

Answer 21

Double-lumen endotracheal tube

Question 22

Why do we need to deflat the lungs before thoracocopy?

Answer 22

To easily get through the thorax

Question 23

What are the 2 access to subcutaneou & extraperitonael surgery?

Answer 23

Balloon dissection
Subcutaneou surgery

Question 24

Which i sthe one effective for retroperitoneal locations for inguinal hernias, retroperitoneal surgery for adrenalectomy?

Answer 24

Balloon dissection

Question 25

What is the most widely used MIS in Cardiac, vascular, and plastic surgery?

Answer 25

Subcutaneous surgery

Question 26

What vein is punctures in subQt surgery?

Answer 26

Saphenou vein

Question 27

What surgery is done to assist with difficult cases before conversion to celiotomy?

Answer 27

Hand-assisted laparoscopic access

Question 28

What is hand-assisted laparoscopic access?

Answer 28

Combine the tactile advantages ofopen surgey with the minimal access of laparoscopy & thoracoscopy

Question 29

What are the diff approaches to natural orifice transluminal endoscopic surgery access?

Answer 29

Transvaginal, transvesical, transanal, transcolonic, transgastric, and transoral approaches

Question 30

What access uses a single skin incision, multiple low-profile trocars can be placed seaparately

Answer 30

Single-incision laparoscopic surgeru access

Question 31

What are the advantages & disadvantages?

Answer 31

Advantage: conventional laparoscopic tools employted

Disadvantage: becomes apparent when an extraction site is needed

Question 32

What is the guideline in placing of trocars in Port placement?

Answer 32

Left and right hand should be placed at least 10cm apart

Question 33

What type of camera is used in imaging systems?

Answer 33

Charge-couple device

Question 34

What is the most comon energy source in endoscopic and endoluminal surgery?

Answer 34

Radiofrequency electrosurgery

Question 35

What areh 2 most common methods of deliverying RF electrocautery?

Answer 35

Monopolar and Bioplar electrosurgery

Question 36

What is the use of monopolar electrosurgery?

Answer 36

• better for tissue dessication and vaporization
• least amt of themal injury & coagulation necrosis

Question 37

What is the Argon beam coagulation best for?

Answer 37

Coagulation of diffusely bleeding surfaces

Less value in laparoscopic procdures

Type of MOnopolar electrosurgery

Question 38

What is the use of Biolar electrosugery?

Answer 38

Best mthd of small-vessel coagulation without theral injury to adjacentt issuses

Question 39

What are the mechanisms of unrecognized visceral surgery?

Answer 39

1. Capacitive coupling = plastic trocar insulates the abdominal wall
2. Direct coupling = current is transmitted directly

Question 40

What is the use of Bipolar electrocoagulation?

Answer 40

Thermal hemostasis

Question 41

What are the diff lasers used for medical application?

Answer 41

CO2 laser
Neodymiumyttrium-aluminum garnet
Frequency-doubled/KTP laser
Laser tecbology
Ultrasonic energy

Question 42

What are the diff robotic surgeries?

Answer 42

Laparoscopic camera holder
Master-slave surgical platform
Da Vinci Intuitive Surgical Sunnyvale, CA
Robotic prostatectomy
Female pelvic surgeyr with Da Vicnci robot
Telesurgery

Question 43

What are the categories of stenting?

Answer 43

Plastic
Metal
Drug-eluting stents
Covered metal
Anchored grafts
Removable covered plastic