types of surgery Flashcards
4 benefits of DaVinci robot
o Small incisions
o Surgeon able to see 10x magnification of vessels for safe dissection
o Endowrist of robotic arm mimics the wrist movement but allow for 360 degree articulation
o No tremor is conveyed to robotic instrument
camera choices for robotic arm
o Camera choices are 0 degree or 30 degree
instruments commonly used with robotic arms
o Maryland grasper with bipolar cautery o Scissors with monopolar cautery o Prograsp o Fenestrated grasper o Caudier grasper o Cautery hook o Large needle driver o Large suturecut needle driver
most common type of robotic surgeries
o Urologic and GYN is predominant field
Prostatectomy – 90% of prostate cancer is done robotically
Hysterectomy – 60% of hysterectomies
Cystectomy
Sacroculpopexy
other than GYN and URO what other specialties use robotic surgery
Nephrectomy
Adrenalectomy
Sacroculpopexy
a surgical technique for repairing pelvic organ prolapse
what type of surgeries can be robotic in general surgery
Colectomies Nissen Fundoplications Paraesophageal Hernia repair Heller Myotomy for achalasia Bariatric Surgery Cholecystectomy Ventral/Inguinal hernia repair
laparoscopic surgery - what is contained within the monitor
- Monitor for viewing
- Light source for connecting light cable
- Camera source for connecting camera cable
- Insufflator source for connecting gas tubing
- Printer for photos taken during the surgery
Opposite the video tower for viewing by the assistant surgeon
Accessory Monitor (slave)
insufflator source contains a
The machine has a preset flow rate and preset pressure
Preset pressure is
15mm/Hg – never higher than 20mm
Flow rate is initially set at
Flow rate is initially set at 3mm (low flow) and then set to 40mm
A millimeter of mercury what type of unit of pressure
A millimeter of mercury is a manometric unit of pressure
After the patient is draped
The assistant will secure the insufflation tubing to the drape with a_______ or ______
After the patient is draped
The assistant will secure the insufflation tubing to the drape with a non-penetrating towel clamp or velcro on drapes
the assistant hands of this end of the insufflation tube
The assistant will hand off the other end (with the filter) of tubing to the nurse for connection to the INSUFFLATION SOURCE
The first scope size is determined by the size of
The first scope size is determined by the size of the port incision – if the surgeon makes a very small incision and uses a 5mm port, then you would choose a 5mm scope to start
10mm 0 degree
10mm 30 degree
5mm 0 degree
10mm 30 degree
Once the camera light source is turned on – the assistant will
white balance the camera by aiming the scope at a white lap sponge or raytex and pushing the “w” button on the camera head
White balance can NOT be done when
the light source is on “stand by” – always look at the display on the light source first before initiating white balance
PNEUMOPERITONEUM will use this type of needle introduced into laparoscopic sugery
The surgeon will then introduce a VERESS needle into the patient’s abdomen – there are many varieties –
how would you check the placement of a needle in a laproscopic surgery
how do you check for laminar flow and the make sure that the needle is not in a vessel
10cc of saline in a syringe is twisted on to veress needle to check placement
The surgeon will aspirate first – to check that the needle is not in a vessel and then inject saline – to check that the flow is laminar
after the syringe has been removed, the placement of the needle of confirmed what would the the assistant do next in a pneumo lapro surgery
The syringe is removed and the assistant places the insufflation tubing onto the veress needle
A Veress needle
is a spring-loaded needle used to create pneumoperitoneum for laparoscopic surgery. Of the three general approaches to laparoscopic access, the Veress needle technique is the oldest and most traditional.
if the veress needle is not deep enough or into a organ you will most likely see a pressure that is
what would you do to amend this
too high
pull back and see if the pressure drops
what is low flow with a veress needle and what is high flow
The veress needle only allows low flow (3)so can ask for high flow (40)
why do we use Co2 for a pneumo laparoscopic surgery
Inexpensive
Non-combustible
Very soluble and reduces risk of gas embolism
what is a a gas embolism
Gas embolism:
blood vessel blockage caused by one or more bubbles of air or other gas in the circulatory system.
what does it mean to say that the patient is “tight” during a laproscopic surgery
If the pressure is above the preset number – the patient is “tight”
if the pressure drops during pneumo surgery it could be due to
Tubing not engaged properly
Ran out of CO2
Port is leaking or open
what is the preset pressure
the preset pressure (15),
what is the trocar usually used
a 10 or 12mm port with trocar is placed
if small 5mm
cleaning the camera scope before introducing it to the port helps reduce
condensation
how can you adjust the focus of a camera
Focus can be adjusted with the dial on the camera head
this part of the trocar must always be within the view of the surgeon
The surgeon will need to see the tip always!
for a 0 degree trocar the camera must be pointed
Camera head is up
Light cable is pointing up (for 0 degree)
direction the light cord is pointing is the direction of view
how can you prevent the camera from fogging
To clear up the “foggy” view, take out the camera and either wipe the scope on the FRED sponge or dip it in the FRED solution. The best way is hot water (in a thermos) if available; followed by tapping the excess off
before dipping the camera in the fred solution you must
Wipe the scope clean with lab sponge before dipping in FRED
internal cleaning of the camera can be done by
Clean scope by briefly touching liver (never the intestines)
FRED stands for
FRED stands for Fog Reduction Endoscopic Device
why do you hold the scope from the top
Holding the scope from the top allow you to use the focus dial with one hand
The scope should be looking between
The scope should be looking between the 2 ports that the surgeon is using
Keep the surgeon’s instrument in the
Keep the surgeon’s instrument in the middle of the screen
If blood hits your scope –
do nothing UNLESS the surgeon asks you to clean the scope -
who can be a first assist
- A PHYSICIAN ASSISTANT
- AN MD/DO
- AN RNFA
- Not an NP
what can PAs do under supervision
- Incisions
- Placement of laparoscopic and robotic trocars
- Cutting/tying VESSELS
- Drilling/sawing/malleting BONE
- Laparoscopic stapling/clipping/cutting of tissue/vessels
- Placement of drains
- Any invasive action
without supervision PAs can
- closing all incisions
- sewing in drains
- Stapling skin
- Steristrips/dressings
- removal or placement of bladder catheter
- whatever needs to be done before the patient moves off operating table
Maintains Sterile Field
Control of Surgical Instruments
PASSES STERILE INSTRUMENTS AND EQUIPMENT TO SURGEON OR ASSISTANT SURGEON
RESPONSIBLE FOR KEEPING COUNT OF SUTURE NEEDLES AND LAP SPONGES ETC
surgical tech
what does a circulation nurse do
- Monitors Sterile vs Non-Sterile Field
- Non-Sterile person
- Provides Scrub with whatever the Scrub wants!
- Assists Anesthesiologist
- Once patient is on the OR table, will ready the patient for surgery
how do circulating nurses prepare pts for surgery
- Placement of EKG leads
- BP cuff
- Finger oximeter
- Sequential Devices for legs
- Blankets for warmth
- Placement of foley catheter
