SR 37 - Laparoscopy

Question 1

What is laparoscopy?

Answer 1

MIS technique using gas to insufflate the peritoneum and instrument manipulated through ports with video camera guidance

Question 2

What gas is used and why?

Answer 2

CO2
Better solubility in blood - less risk of gas embolism
Noncombustible

Question 3

What operation are performed with the laparoscope?

Answer 3

Frequent - cholecystectomy, appendectomy, inguinal hernia repair, ventral hernia repair, Nissen fundoplication
Infrequent - Bowel resection, colostomy, sugery for PUD, colectomy, splenectomy, adrenalectomy

Question 4

CI to laparoscope?

Answer 4

Absolute - hypovolemic shock, severe cardiac decompensation

Relative - extensive intraperitoneal adhesions, diaphragmatic hernia, COPD

Question 5

Associated complications of laparoscopy?

Answer 5

Pneumothroax
Bleeding
Perforating injuries
Infection
Intestinal, solid organ, major vascular and bladder injury
CO2 embolism
Hernia at larger trocar sites
DVT

Question 6

Classic findings in a CO2 gas embolism?

Answer 6

Hypotension
Decreased end tidal CO2
Mill-wheel murmur

Question 7

What prophylactic measure shoudl every patient get when they are having a laparoscopic procedure?

Answer 7

SCD boots
(OGT - decompress the stomach)
(Foley catheter - pelvic procedures)

Question 8

What are the cardiovascular effects of a pneumoperitoneum?

Answer 8

Increased afterload
Decreased preload
Increased CVP and PCWP

Question 9

What is the effect of CO2 insufflation on end tidal CO2 levels?

Answer 9

Increased
CO2 is absorbed into the bloodstream
Body compensates with increased ventilation to blow of the CO2

Question 10

Advantages of laparotomy?

Answer 10

Shorter hospitalization
Less pain and scaring
Lower cost
Decreased ileus

Question 11

What is the Veress needle?

Answer 11

Needle with spring-loaded, retractable, blunt, inner-protective tube that protrudes from teh needle end when it enters the peritoneal cavity
Used for blind entrance and then insufflation of CO2 through it

Question 12

How can it be verified that the Veress needle is in the peritoneum?

Answer 12

Syringe of saline

Saline flows freely without pressure through the needle ‘drop test’

Question 13

What is the Hasson technique?

Answer 13

No veress needle

Cut down and place trocar under direct visualization

Question 14

What is the cause of post-laparoscopic shoulder pain?

Answer 14

Referred pain from diaphragm - gets stretch from CO2 and irritation

Question 15

What is FRED?

Answer 15

Fog Reduction Elimination Device

Sponge with antifog solution used to coat the camera lens

Question 16

What is the safest time for laparscopy during pregnancy?

Answer 16

Second trimester