Module 1

Question 1

Laparoscopes lengths

Answer 1

Length: 30-45cm
Diameter: 2-10mm

Question 2

What are the degrees for scopes?

Answer 2

0 degree: best for small area in direct line with scope and working ports (ex. deep in pelvis or high in mediastinum), some have flexible tip

30 or 45 degree: offers more versatility

Question 3

Hopkins Rodland system

Answer 3

a way to transmit light from source to operative field and capture reflected light and transfer back to camera
- light decreases as scope lengthens, diameter decreases, or angle increases
- damage can occur as length increases or diameter decreases

Question 4

What do newer devices use instead of Hopkins Roland system?

Answer 4

• chip is at the end of the scope so it doesn’t have to go back
• a flexible tip, brighter image, high definition capture chips

Question 5

What set up do you need for laproscopic surgery?

Answer 5

• equipment needed to open and close ports sites
• standard open surgical equipment in case you need to open

Question 6

What do you do if you image is dark or blurry?

Answer 6

• check fiberoptic by holding lends up to light and looking into light cord attachment –> black spots present if fibers are damaged
• look at lens for obvious damage
• look if moisture in eye piece between cope and camera –> fix by drying with a gauze

Question 7

How do you defog the lens?

Answer 7

• Fred: chemical agent, let dry for a few seconds before reinsertion
• can keep in hot water/bath or insulated bottle

Question 8

How do you clean smudged lens?

Answer 8

wiping scope on clean tissue, removing scope and cleaning with hot/water gauze pad, and clean mechanical seal/port

Question 9

What gas is used in laparoscopy?

Answer 9

CO2: inexpensive, does not support combustion

• always need new tank with wrench in room
• or use a central CO2 line

Question 10

What is use of warmed/humified CO2 associated with?

Answer 10

differences in pt body temp and post op pain –> not clinically significant (es if surgery <90min)

Question 11

what is the insulator system?

Answer 11

controls flow of gas from COO2 to abdomen

Question 12

What is high flow?

Answer 12

10+L/min

Question 13

what does the insufflations system show?

Answer 13

pressure preset, gas flow preset, amount of gas used, current abdominal pressure

Question 14

What is the sterile gas line with filter?

Answer 14

• filter stops pt products going between patients
• attached with lure lock or push on tube

Question 15

What three suction devices are needed?

Answer 15

Anesthetist, NG, operative field

• can lead to decreased CO2, so fully immerse suction catheter in fluid to prevent loss of pneumo

Question 16

what are the components of the video tower?

Answer 16

light source: 300 watt Xenon lamp (light cables: check quality of cable by holding up to light and looking for black dots)
camera control unit
video monitor
insufflator

Question 17

what type of monitor is needed for high def camera?

Answer 17

ideally one that can display high def images

Question 18

what is Picture in Picture?

Answer 18

displays an image in corner with the laparoscopic image still up (ex. US if intraop US is needed)

• useful for hysterooscopy, liver US/bx, common bile duct exploration

Question 19

what might the CO2 gauge read if connected to central CO2 supply?

Answer 19

empty

Question 20

trouble shooting steps

Answer 20

1. check co2 tank is attached and full, gasket isn’t damaged and spare gasket/tank is available
2. all cables are correctly and securely connected
3. all equipment needed is present

Question 21

what is role of circulator?

Answer 21

• monitor co2 level
• monitor insufflator settings
• monitor energy source, check cables, assist monitor positioning, assist with photo documentation

Question 22

how to trouble shoot loss of working space?

Answer 22

1. check insufflator display

Question 23

actual pressure>set pressure:

Answer 23

Flow rate=0, check actual and set pressures of pneumo
-pt may not be relaxed enough (check status os muscle relaxation)
- may be mechanical blockage in tube or at valve port (check valve on port connected to insufflator tubing and tubing along its path)

Question 24

actual pressure<set pressure:

Answer 24

flow rate=high
- check if tubing disconnected from insufflator or port
- check ports for leaking around insertion site or through mechanical seal, check port sites for leaking coo2
- check if dissension into bowel or bladder (is co2 going there?)

Question 25

pressure low and flow rate=0

Answer 25

• check insufflator (power on, not standby)
• check gas level in tank

Question 26

what can cause the monitor to go blank?

Answer 26

• disconnected power cords
• disconnected video cables
• blown light source bulb
• disconnected light cable (at scope or light source)