MIS Flashcards
What are the 6 components of MIS?
Camera and camera control unit (ccu) Telescope Light source and fibre optic light cable Video monitor Any peripherals required for recording/documentation Video cables
You need to get the camera ready for a procedure, what should you do?
Inspect camera head
Plug camera into ccu and turn unit on
Set parameters to manufacturer and surgeon preference
Check focus and white balance capabilities
What should the scrub nurse do to get the telescope and light cord ready?
Look through telescope and check for clarity
Hold one end of the light cable up to a rm light and look at the opposite end. Should have clear light shining through.
What do black spots when mean looking through the light cable held up to a light source?
Damage
What is important to remember about the light cord?
It gets hot at end but not if tip is on. If tip off then could burn drapes, etc. do not place on or near flammable sources
What is the co2 insufflator used for?
To inflate stomach
What is the normal adult pressure for the Insufflator?
15mm/hg
What is the Hassan technique?
Inserting port for laparoscopic surgery with open technique. Most commonly used
What is the verres technique?
Needle inserted into abdomen blindly that then inflates the abdomen wi co2. More dangerous
Inserting co2 into the abdomen is known as creating a what?
A pneumoperitoneum
How do trocars work?
They create an orifice to work through by inserting through a cannula through the abdomen and is then removed leaving the cannula behind to work through.
What is important to remember about the cauterization instruments in laparoscopic surgery?
You need to check the long black tube insulation for cracks as this could transmit at crack and cause damage to tissue
How does the supine position create complications during MIS?
Respiratory complications, increased intraabdominal pressure,
Hypoxia can result and co2 absorption from peritoneal cavity can aggravate situation.
How does the reverse trendelenburg position create MIS complications?
Rspiratory advantage for lungs
Cardiac disadvantage because the heart has to work harder to get blood flow back up vs supine where it is all at gravity level.
Why is co2 used to create a pneumoperitoneum?
It is absorbed better
What are some tissue/organ injuries that could happen during MIS?
Accidental perforation
Bowel burn
Inadvertent coagulation of tissue
Bowel injury
A crack in the black tubing of the laparoscopic instrument that can burn surrounding tissue by accident is known as what?
Insulation failure
What is direct coupling?
Electrical energy is flowing eg. Through bovie, and it touches an Un-insulated object. The current is then transferred through that object and any tissue surrounding it will also be affected unintentionally
What is capacitive coupling?
When a well inspected insulated laparoscopic instrument is used within a narrow space, eg. In a metal cannula, it can transfer the energy through the insulation and onto the other metal of narrow space which can transfer the energy to any nearby tissues that it may be in contact with.
What is the first zone of injury?
Area of intended tissue reaction visualized by surgeon
What are 2 and 3 zones of injury?
Areas where accidental injury occurs as result of insulation failure, direct coupling, or capacitive coupling
What is zone 4 of injury?
Area on endoscope where surgical team can sustain burn as a result of problems with electrosurgical instruments
How can a trocar site hernia be prevented?
Ensuring tissue layers at trocar site are completely closed
What can cause hypertension as a complication in an MIS pt?
Pts position from increased abdominal pressure. Increased co2 absorption
What are some complications of hypothermia?
Increase stress response Increase wound infection rate Longer hospital stay Prolongs recovery Delays drug metabolism Causes hemodynamics instability Cardiac ischemia Depresses cognitive function
What are some access complications of MIS?
Verres needle - misplaced insufflaton
Needle puncture
Trocar placement
Visceral injuries
How do you help prevent N&V during an MIS case?
Hydrate vigorously Reduce narcotic use Use local anesthetic Prophylactic antiemetic Insert NG tube and empty stomach before emergence Use of propofol
Signs of a co2 embolism?
Sudden fall in BP Dysrhythmias Heart murmurs Cyanosis Pulmonary edema Abrupt increase in end tidal co2
