Test 2: Laparoscopic & Robotics (2/3) Flashcards
What is the reported incidence of injury of all laparoscopic procedures?
0.3-1.0%
More than 50% of all complications occur during what?
Initial entry into the abdomen and insertion of trocars
What are complications associated with entry into the abdomen?
-Intestinal, Urinary Tract, and Vascular Injuries
-CO2 gas embolus
Unfortunately, approximately 30% to 50% of these injuries go undiagnosed intraoperatively, resulting in significant surgical mortality (3.5–5%).
Rates as high as 30% mortality have been reported when major bowel and vascular injuries occur.
What are factors that increase risk of injury?
-body habitus & position
-anatomic anomalies
-prior surgery (adhesions)
-surgical skill
-degree of abdominal elevation during trocar placement
-the volume of gas insufflation
Intestinal injuries occur in 0.3% to 0.5% of operative laparoscopies, and less than ____% of these are recognized at the time of surgery.
50%
Untreated intestinal injuries during laparoscopic surgery can lead to what?
-Peritonitis
-Sepsis
-Respiratory Distress
-Multisystem Organ Failure
What is essential to prevent mortality from bowel injuries?
Early recognition and surgical repair is essential to prevent mortality from bowel injuries.
Which technique is associated with a lower incidence of unrecognized vascular and visceral injury?
Open (Hasson) technique
Injury to the urinary tract occurs in 0.5% to 8.3% of cases, secondary to:
Trauma from instrument manipulation, electrocautery, or laser.
How do they recognize injury to the urinary tract?
-Direct visualization of urine leakage from damaged structures
-Catheterization and instillation of methylene blue dye is used when significant risk of damage is suspected.
Placement of the primary trocar under ________ creates the safest distance between the anterior abdominal wall and underlying abdominal contents in order to minimize injury from trocar insertion.
High pressure (25 mm Hg)
The direct entrainment of air and/or other medical gases, such as carbon dioxide, into the arterial or venous system.
Gas Embolism
The mortality rate of a CO2 gas embolism is ____%
28%
True/False: Massive and/or fatal gas embolisms have been reported during all types of laparoscopic procedures including laparoscopic cholecystectomy, liver resection, and hysterectomy.
True
How does a CO2 Gas Embolism Occur?
-It can occur any time there are open vessels that have an intravascular pressure that is below intraabdominal pressure
-The erroneous placement of a Veress needle or trocar directly into the lumen of an intraabdominal vessel.
True/False: Increasing CVP, such as with the use of PEEP, is effective in reducing the incidence of gas embolism.
False; studies have not shown them to be effective
What is the actual incidence of gas embolism during laparoscopic procedures?
65-100%.
Most cases have minor gas embolisms, associated with cardiopulmonary changes, which resolve spontaneously.
What are the signs and symptoms of those larger, CO2 gas embolisms?
-Acute decrease/loss of EtCO2
-Increase in EtNitrogen
-Hypotension/Hypoxia that cannot be explained by deep anesthesia or hypovolemia
-Dysrhythmias, severe hemodynamic instability, CV collapse
What is the most sensitive diagnostic technique for the detection of gas?
Transesophageal Echocardiography
Where would you visually detect the gas embolism?
Right side of the heart and pulmonary outflow tract
Changes in Doppler sounds will occur with volumes of ____mL/kg of gas.
0.5 mL/kg
