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miti Flashcards

1
Q

“Mechanical” hemostasis

A
  • Ultrasound coagulation
  • Transfixation
  • Compression
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2
Q

pneumoperitoneum

A

fill abdomen with air
CO2 (more preferred-less pain)
air
other

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3
Q

other ways than pneumoperitoneum

A

gasless laparoscopy
artificial space

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4
Q

anastomosis

A

a surgical connection between two structures.

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5
Q

The phases of a surgery

A
  • Positioning of the patient
  • Incision
  • Exposure
  • Dissection
  • Resection
  • Specimen retrieval
  • Reconstruction
  • Wound closure
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6
Q

what are retracters

A

to open the abdomen
a) Gillies
b) Volkmann
c) Langenbeck
d) Roux
e) Fritsche
f) Doyen

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7
Q

colonic anastomosis equipment

A

circular stapler for intestinal anastomosis ( replaces suturing)

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8
Q

Preconditions of successful surgery:

A
  • Asepsis
  • Anaesthesia
  • Dedicated workplace
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9
Q

The new approach – single port surgery

A

OPUS: One-port umbilical surgery
TUES: Transumbilical endoscopic surgery
e-NOTES: embryonic NOTES
SLAPP: Single laparoscopic port procedure
SPL: Single-port laparoscopy
SLIT: Single laparoscopic incision transabdominal surgery
LESS: Laparoendoscopic single-site surgery

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10
Q

what NOTES stands for

A

Natural Orifice Transluminal Endoscopic Surgery

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11
Q

NOTES advantages

A

scarless - avoids incisions
reduced trauma
reduced pain
disadvantage: slower

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12
Q

NOTES Potential barriers to clinical practice

A
  • Access to peritoneal cavity
  • Gastric (intestinal) closure
  • Prevention of infection
  • Development of suturing device
  • Development of anastomotic (non-suturing) device
  • Spatial orientation
  • Development of a multitasking platform to accomplish procedures
  • Control of intraperitoneal hemorrhage
  • Management of iatrogenic intraperitoneal complications
  • Compression syndromes
  • Training other providers
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13
Q

Rendez-vous procedures on the GI-tract

A

invasive procedure where a combination of methods are implemented

superior alternative to
risky endoscopical interventions and too invasive pure laparoscopic resections

rendezvous surgeries are creating
the bridge to NOTES

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14
Q

NOTES Preconditions

A
  • Anatomical situation
  • Risk of infection
  • Approachability
  • Closure
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15
Q

NOTES access routes

A

Stomach
+Stomach is sterile
-Long distance via mouth/esop hageous/ difficult closure

Intestine
+Short distance to reach abdominal cavity, use of wide lumen devices possible
-Potentially high infection risk

Vagina
+Easy access and closure, short path, low risk of infection
-only for female patients, long- term consequences regarding fertility

Urethra
+Easy access and closure, short path, low risk of infection
-Urethra is very narrow - combination with other accesses

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16
Q

how to close the entry point

A

viscerosynthesis / clip / tunnel techniques

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17
Q

notes and hybrid common things

A

use of endoscopes
reduced trauma
reduced incision

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18
Q

indications

A

EGD for stomach
colonoscopy
enteroscopy

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19
Q

flexible endoscope parts

A

light guide connector
light guide tube
control body
video remote switches
internal instrument channels
insertion tube
bending section

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20
Q

gastroscopy (egd) indications

A

Epigastric Pain
Dysphagia
Gastrointestinal Bleeding
Surveillance
Therapy (Varices, Tumor, PEG, …)

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21
Q

colonoscopy indications

A

Abdominal Pain
Diarrhea or Obstipation
Gastrointestinal Bleeding
Screening and Surveillance
Therapy (Polyps)

22
Q

endoscopy challenges

A

looping
maneuvring is hard, it could cause complications

23
Q

imaging techniques

A

fiberoptics
video endoscopes
spectral imaging
narrow band imaging

24
Q

why no 3d endoscopes

A

distance between the two camera sources is so small

25
Q

Endoscopic Resection of (Pre-)Neoplastic
Tissue

A

 Forceps Biopsy
 Snare Polypectomy
 Endoscopic Mucosal Resection
 Endoskopic Submucosal Dissection
 Endoscopic Full Thickness Resection
 (Lymphnode Dissection)

(invasiveness increases to downward)

26
Q

devices used to stop gastrointestinal bleeding

A

Hemoclips

27
Q

Robotic-assisted bronchoscopy indications and use cases

A

Ind:
Cough, infection, unusual x-ray

Use cases:
Software based nodule identification and automated segmentation of 3D airway trees
* Virtual path planning previous to the procedure
* Navigation during the procedure
* Visualization of the biopsy attempts and needle trajectories

28
Q

adv- disadv of flexible endoscopic robotic systems

A
  • More precise positioning of catheters with
    sub-mm measurements
  • Easier control, as no sterile dressing is
    needed for the physician
  • Improved ergonomics for the physician

but
* Currently no assisted navigation
* No force sensing or feedback technology
* Higher costs

29
Q

camera guidance systems

A

Indirect Control:
* Joystick
* Head Control
* Voice Control
* Color Tracking
* Instrument Tracking

Direct Control
* Eye Tracking

increased degree of automation downwards

30
Q

what for robotics are currently helpful

A

diagnostics
bronchoscopy
biopsy sampling
endovascular interventions

31
Q

aurora applications to support OR staff

A

handing of surgical gloves
handing of suturing material
adjustment of medical devices

32
Q

aurora challenges

A

navigating is difficult
limited space
cables all around
ethical legal concerns

33
Q

why no autonomus robotic system

A

compelxity of surgery is too high
every patient is different
legal ethical concernd
sensing in a dynamic environment is hard
robustness reliability

34
Q

freq range of ultrasound

A

1-20 MHz

35
Q

adv disadv of ultrasound

A

Adv
Real time examination
Point-of-care diagnostic (portable, bed-side)
Lower in cost
No use of harmful ionizing radiation

Disadv
No retropective evaluation of examination
Limits on field of view (behind bone/ air)
Need for patient cooperation
Dependence on physician
Difficult reproducability

36
Q

ulrtasound high low freq difference

A

High frequency
-> high resolution
-> less penetration

​Low frequency
-> less resolution
-> more penetration

37
Q

ultrasound cw pw

A

Continuous Wave-Doppler:
- Separate transmission and reception of ultrasound
- Region of interest is determined by the overlap of the transmit and receive ultrasound beams

Pulsed Wave-Doppler:
- same element for transmit and receive
- Region of interest is determined by depth and lenght of the gate

38
Q

ultrasound use cases

A

diagnositcs
- A-Mode, B-Mode, 3D/ 4D-Ultrasound
- Elastography

Therapy
- Lithotripsy
- Surgery
- Electrotherapy
- Phacoemulsification
- Thrombolysis
- Dental

39
Q

problems of ulrtasound

A

Shadowing
Translocation
Enhancement
Mirroring

40
Q

dissection vs coagulation

A

dissection
Fast heating of tissue
Increase of intracellular pressure
Explosively rupture of cell walls
Separation of tissue

coagulation
Slow warming of tissue
Vaporization of intra- und extracellular fluids
Shrinking of tissue
Coagulation

41
Q

Generator´s ability to coagulate without/during cutting

A

Crest-Factor = k = Umax/Ueff
= Ratio of peak values to the effective value

Ideally the top layer of the surface is shrunk slowly
without further penetration

Coagulation increases with crest factor

42
Q

Neutral electrode advantages

A

helps to separate the tissue without damage
avoid tissue gets wed or get in touch with blood

43
Q

risk factors of electrosurgery

A

explosions
pacemaker
nerve irritations
current leakage

44
Q

‘Master-apprentice principle’ in surgery

A

You need a mentor who is an expert in his or
her field.

Individual ‘masters’ use different techniques for
one and the same procedure.

45
Q

young surgeons problem

A

 Prepare the morning visitation
 Present cases in tumor panels
 Schedule dates
 Check lab parameters
 Check patient files
 Manage emergencies
 Write documentation
 Care wounds
 Assist in surgies

few time for practice and training

46
Q

Problems of the classic training concept:

A
  • Several types of surgical procedures are distributed among different centers.
  • ‘Simple’ cases occur less frequently in educating hospitals, as they are increasingly performed in a out-patient
    setting.
  • High specialization of hospitals has led to a ‘narrowing of training’.
  • Big Problem: Much time between individual surgeries → rather no learning effect → little routine!
47
Q

in vitro training adv disadv

A

In-vitro trainers
* Cheap
* Portable
* Reusable
* No risks of infection

  • Cannot be used to simulate entire sophisticated
    open surgical procedures
  • Only simulation of basic tasks
  • Haptics are not comparable with real organs
48
Q

Human cadaver training adv disadv

A
  • True anatomy
  • Practice entire operations
  • No operation that cannot be simulated
  • Haptics of real human organs
  • Very expensive.
  • Cadaver can usually only be used once
  • Risk of infection
  • Difficult to organize
  • Ethical discourse / governmental regulation
  • (patients’ consent needed!)
49
Q

virtual training adv disadv

A
  • Reusable
  • Does not require any great preparations
  • Recording of events during surgery
  • Lots of minimally invasive scenarios
  • Very expensive
  • No realistic haptics
  • Focus on minimally invasive surgery
  • Hardly possible to convey motor skills
50
Q

need for intelligent OR

A

Sensors
Preprocessing
Feature extraction
Analysis
Model
Deployment

51
Q

Data sources in the OR:

A

Patient Data
Device Data
LaparoscopyVideo
Room Video
Audio
AdditionalParameter

52
Q

Sensor data fusion -> difference by fusion types

A

Early Fusion
* Combining (concatenation, pooling, etc.) multiple input modalities into one feature vector before feeding into a machine learning model
* Type 1: Fusion of the original features
* Type 2: Fusion of extracted features

Joint Fusion (using neural networks)
* Merge learned feature representations from intermediate layers and features from other modalities
* Difference from early fusion: loss is propagated back to the feature extracting neural networks
* Type 1: Feature extraction using neural networks of all modalities
* Type 2: Feature extraction only partially using neural networks

Late Fusion
* Decision-level fusion: using predictions from multiple models to make a final decision
* Aggregation functions are used to combine predictions from multiple models:
* Averaging
* Majority voting
* Weighted voting
* Meta-classifier

mmm (13 decks)

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