Principles of Minimally Invasive Surgery (26) Flashcards
Dr. Gilley
What is endoscopy?
use of instrument (i.e. an endoscope) to visualize interior of organ or body cavity that cannot be examined without surgery
What is flexible endoscopy?
endoscope that bends to look and/or move around corners
What are the components of flexible endoscopes?
What is this?
flexible endoscope
What are immersible scopes?
have handles placed in water without risk of damage
Label A-C
A. umbilical cord
B. handle
C. insertion tube
What is rigid endoscopy?
plastic or metal scope that can’t bend
What are the parts of a rigid endoscope?
lens
obturator
trocar
How does a rigid endoscope work?
inserted into the body through skin and soft tissue or a natural orifice
What is an insertion through the skin called with a rigid endoscope?
portals
How are the portals defined by?
- scope inserted through scope or camera portal
- power and hand tools inserted through instrument portal
What are cannulas?
metal tubes that maintain portals and protect instruments
What is triangulation??
visualization of instruments through scope to perform biopsies or therapeutic procedures within the body cavity
What is gastroduodenoscopy?
endoscopy of esophagus, stomach, & duodenum (occasionally upper jejunum)
What is bronchoscopy?
endoscopy of trachea and bronchi
What is laryngoscopy?
examination of the pharynx and larynx
What is laparoscopy?
endoscopy of peritoneal cavity
interventional
In what ways can laparoscopy perform minimally invasive surgery?
- gastropexy
- jejunostomy tube placement
What are arthroscopes always used through?
cannulas
What is instrumenting?
insertion of endoscope, arthroscope, or other instrument into joint
What is triangulation?
visualization of instruments through the scope to perform biopsies or therapeutic procedures in the joint
How does arthroscopy work?
- scope inserted through scope or camera portal
- power and hand instruments inserted through instrument portal
- fluid flowing into joint - ingress
- fluid flowing out of joint - outflow or egress
Why is endoscopy used?
to biopsy organs, remove foreign objects, examine inside hollow structures
perform proceeders done by more invasive surgery
When is endoscopy valuable?
only when successful - eliminates need for more invasive surgery
When is gastroduodenoscopy indicated?
gastric and intestinal biopsy/cytology for diagnosis of infiltrative and lymphatic disorders
When is an esophagoscope indicated?
When is a proctoscopy and colonoileoscopy indicated?
- biopsy
- ID of occult whipworm infestation
- diagnosis/removal of polyps
- diagnosis of cecocolic intussusception
When is laryngoscopy indicated?
When is cystoscopy indicated?
- diagnosis of ectopic ureters
When is a thoracoscopy indicated?
When is bronchoscopy indicated?
When is rhinoscopy indicated?
When is a posterior nares (choanal) examination indicated?
When is laparoscopy indicated?
exam and bx of abdominal viscera
determine if celiotomy indicated
minimally invasive interventional surgery
When is arthroscopy indicated?
What are the characteristics of flexible endoscopes?
- greater access to more sites in viscous organs
- more expensive than rigid scopes
- easier to damage/requires training to assemble and clean without damage
- requires substantial training to use properly
What are characteristics of rigid endoscopes?
- less expensive than flexible scopes
- usually more durable
- easier to learn to use
- capable of larger biopsies than with flexible scopes
- excellent for simultaneous removal of foreign objects and protecting mucosa
What are the tips of foreign body retrieval forceps from top to bottom?
shark’s tooth forceps
rat’s tooth forceps
coin retriever forceps
What do four-wire basket retrieval forceps help do?
retrieve foreign bodies
What are these?
both four-wire baskets
top works well due to great flexibility of wires; bottom harder to ensnare foreign bodies
What are the 2 types of rigid biopsy forceps?
upper forceps: clamshell or double spoon forceps
lower: smaller upper punch fits into larger lower cup with shearing scissor-like cut
What are some rules for endoscope care?
- always use a mouth gag
- review manufacturers recommendations
- never subject flexible scopes to heat, especially autoclaving!
What are the 4 basic principles for most endoscopic procedures?
- advance scope only if you can see where you are going
- can’t see? back scope out a little and/or insufflate a little air/infuse some fluid into the lumen
- aim scope toward center of lumen
- do not insert endoscope into patient hard!
What are the advantages of endoscopic removal of foreign objects?
- faster than surgery
- less stressful to the patient
- reduced tissue trauma, morbidity, and recovery time
- reduced cost to client
What are disadvantages of endoscopic removal of foreign objects?
- cannot remove all objects
- can hurt patient with careless technique
- requires assortment of expensive foreign body retrieval devices
What is the most common arthroscopically performed procedure?
fragment removal: OCD, FCP
Why is arthroscopy superior to radiography in diagnosis of joint disease?
- allows direct visualization of cartilage and soft tissue structures
- provides magnification
- enables biopsy of virtually all structures within a joint
What is the most significant diagnostic advantage of arthroscopy?
ability to access condition of cartilage surface!
What are the common diagnoses with arthroscopy in the elbow?
fragmented (medial) coronoid process
osteochondritis dessicans
What are common diagnoses with arthroscopy in the carpus?
- osteoarthritis
- chip fractures
What are common diagnoses with arthroscopy in the hip?
- osteoarthritis
- labral tearing and avulsion
- tearing of ligament of femoral head
- neoplasia
What are common diagnoses with arthroscopy in the stifle?
- osteochondritis dessicans
- cruciate disease/damage
- osteoarthritis
- meniscal disease/damage
What are common diagnoses with arthroscopy in the tarsus?
- OCD
- chip fractures
Which arthroscope size is usually recommended?
1.99 mm - less damaging
What are common arthroscopic procedures in the shoulder?
fragment removal
OA treatment
biceps tenotomy
soft tissue shrinkage for instability
What are common arthroscopic procedures in the elbow?
- fragment removal
- OA treatment
What are common arthroscopic procedures in the carpus?
fragment removal
OA treatment
What are common arthroscopic procedures in the hip?
OA assessment
biopsy
What are common arthroscopic procedures in the stifle?
meniscal tear treatment
cruciate ligament debridement
fragment removal
OA treatment
What are common arthroscopic procedures in the tarsus?
fragment removal
OA treatment
Label the parts
A. grasping forceps
B. right angle probe
C. microcurette
What is important to know with arthroscopy?
- you may not be able to successfully remove all fragments
- be prepared to perform an arthrotomy
