Test 2 Laproscopy and Robotic Surgery Flashcards
what surgery was the first to be done laproscopically?
cholecystectomy
common surgeries where laparoscopic and robotic techniques are used
- general surgery
- gynecologic surgeries
- urologic
- orthopedic - specifically arthroscopy
benefits to minimally invasive surgery?
- smaller incisions
- less postop pain
- decreased incisional stress response 4. decreased rate of complications
- faster recovery
- decreased LOS
- overall improved pt satisifaction
Disadvantages of minimally invasive surgeries
- sequela of pneumoperitoneum
- positioning challenges
- need for specialized training
laparoscopic surgery requires the creation of an artificial pneumoperitoneum, this done by?
instillation of air/gas into a cavity under controlled pressure
what are the two most commonly used entry methods in lap surgery to create a pneumoperitoneum
- closed technique
- open (hasson) technique
what gas is used to insufflate the peritoneal cavity during lap surgery to allow visualization of the organs
CO2
why is CO2 the gas of choice for insufflation during laproscopic surgery?
- non toxic
- nonflammable
- readily absorbed into the blood stream with minimal risk of air embolization
- produces less hemodynamic effects than other nonflammable gases (argon)
during laparosocpic surgery, when insufflating CO2 for creation of pneumoperitoneum, the intra-abdominal pressure needs to be limited to ________ mmHg
15
describe the closed technique for creating pneumoperitoneum during lap surgery
use spring loaded needle - veress needle to pierce abdominal wall at thinnest point around the umbilicus
describe the open technique to create a pneumoperitoneum during laparoscopic surgery
make 1 - 2.5 mm midline vertical incision that begins at the lower boarder of the umbilicus and extends through the subQ tissue and underlying fascia
what part of laparoscopic surgery is responsible for the large majority of complications that occur?
creation of the pneumoperitoneum
the creation of a pneumoperitoneum for laparoscopic surgery causes increased intrabdominal pressure, what effect does this have on CV/hemodynamics?
- increase: SVR, MAP, and HR
- decrease: SV
physiological effects of pneumoperitoneum depend on what factors?
- degree of intra-abdominal pressure 2. length of surgery
- patient position
- perioperative volume status
- patient age
- presence of co-morbidities, esp cardiopulmonary ones.
CV effects of pneumoperitoneum (for laparoscopic surgery)
- variable effects on cardiac filling pressures
- CO reduction of 20-50%
- SV reduction secondary to increased IAP
- CO2 absorption can cause myocardial depression/arrhythmias
- has effect on cardiac conduction system
how can you decrease CO reduction with pneumoperitoneum?
adequate fluid load and compression stockings prior to surgery
how can you ensure stroke volume is not reduced with pneumoperitoneum (for lap surgery)?
- adequate perioperative hydration
- changes in patient position
- application of compression stockings
what has the greater effect on cardiac filling pressures during laparoscopic surgery - the pneumoperitoneum or positioning?
positioning
during laproscopic surgery, what position will increase CVP, ICP, IOP and cause head/airway edema?
trendelenburg
during laparoscopic surgery, what position will reduced cardiac preload; therefore, reducing CO
reverse trendelenburg
with creation of pneumoperitoneum for laparoscopic surgery, CO2 absorption that makes PaCO2 > 60, will cause what effect on the CV system?
myocardial depression and arrhythmias
with creation of pneumoperitoneum, CO2 absorption –> PaCO2 45-60, will have what effect on the CV system?
little CV effect
high pressure insufflation of pneumoperitoneum can lead to what cardiac conduction changes?
- prolong QT dispersion = ventricular instability –> increased arrhythmias and cardiac effects
- bradycardia
how does laparoscopic surgery/pneumoperitoneum affect the respiratory lung mechanics?
- decrease compliance
- decrease FVC
- decrease FEV1
- decrease FRC
- increase PIP