Questions and Answers
What is the maximum volume of CO2 that should be delivered for insufflation during pneumoperitoneum establishment?
Which method of establishing pneumoperitoneum involves a paraumbilical incision and the use of a Verres needle?
What is a potential consequence of overpressurization during CO2 insufflation?
During the open method of pneumoperitoneum establishment, what is the first step after making an incision through the umbilicus?
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Which of the following is NOT a recognized anesthetic consideration during minimally invasive surgery?
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What is the primary advantage of minimally invasive surgery (MIS) over traditional open surgery?
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Which of the following describes an endoscope?
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What is pneumoperitoneum, and why is it important in MIS?
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Which component of the endoscopic instrumentation transmits light to the surgical site?
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In which scenario might a surgeon convert from an MIS approach to an open surgery?
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What role does the camera play in minimally invasive surgery?
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Which of the following is NOT a type of trocar system used in MIS?
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What must the nursing team prepare for before an MIS surgery?
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Study Notes
Definition and Terminology
- Minimally Invasive Surgery (MIS) refers to surgical techniques that utilize advanced technology, reducing the need for large incisions.
- Other terms for MIS include Endoscopic Surgery, Laparoscopic Surgery, Minimal Access Surgery (MAS), Single Puncture Access (SPA), Single Port Surgery (SPS), One Port Umbilical Surgery (OPUS), and Natural Orifice Transluminal Endoscopic Surgery (NOTES).
MIS Versus Open Surgery
- MIS techniques result in less postoperative pain, shorter recovery times, and reduced scarring compared to traditional open surgery.
Endoscopic MIS Instrumentation
- Endoscopes: Available in flexible, rigid, or semirigid forms; can be diagnostic or operative.
- Light Sources and Fiberoptic Cables: Essential for visibility; require safe handling to avoid contact with skin or flammable materials; includes white balance and multiple glass fibers for light transmission.
Trocar System
- Composed of an obturator and a sleeve (cannula), trocars can be disposable or reusable (like Hasson Trocar).
- Functions to insert and remove MIS instruments; initial insertion provides access to the operative site.
- Process involves inserting the obturator and sleeve, removing the obturator, and repeating for additional sites if necessary.
Camera Setup
- A non-sterile device connected to the endoscope must be draped with a sterile sleeve to maintain a sterile environment during surgery.
MIS Instruments
- Instruments include clip appliers (disposable or reusable), suturing devices, retrieval devices (Endocatch), and stapling devices.
- Nursing teams should prepare open instrumentation for all MIS surgeries to facilitate conversion if necessary.
Grasping & Dissecting Instruments
- Specific tools utilized to manipulate and dissect tissues are essential for effective MIS.
Video Technology Components
- The basic components of a medical video system for MIS include an endoscope, light source, camera head, camera control unit, video monitor, and recording system.
Robotics in MIS
- Robotics are increasingly integrated into MIS for enhanced precision and control during surgical procedures.
Pneumoperitoneum
- Created to visualize abdominal structures; involves CO2 delivery through insufflation tubing with a rate of 15-20 liters per minute and volume of 2.5 to 4 liters at a pressure of 14 to 16 mm Hg.
Establishing Pneumoperitoneum
- Closed Method: A paraumbilical incision is made, followed by Verres needle insertion. Confirmation of placement is done via aspiration and saline instillation, then CO2 gas is insufflated.
- Open Method: An incision is made through the umbilicus, the peritoneum is incised, and a Hasson Trocar is placed. Stay sutures are applied, and CO2 is insufflated.
Safety Considerations
- Overpressurization risks include increased CO2 levels, leading to complications such as hypercarbia, gastric regurgitation, reduced respiratory function, and increased postoperative pain.
Anesthetic Considerations during MIS
- Important anesthetic considerations include hypothermia, hypoxia, increased peripheral resistance, potential CO2 gas emboli, gastric reflux, subcutaneous emphysema, and pneumoscrotum.
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Description
This quiz covers the essential concepts of Minimally Invasive Surgery (MIS), including the definition of endoscopic surgery and its instrumentation. You will learn about pneumoperitoneum, potential complications, and the criteria for converting from MIS to open surgery. Perfect for students or professionals seeking to enhance their surgical knowledge.
