Module 12: Minimally Invasive Surgery

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Questions and Answers

What is the primary purpose of using minimally invasive surgery techniques?

To require larger incisions

To increase postoperative discomfort

To prolong hospital stays

To minimize recovery time and complications (correct)

Which of the following terms refers specifically to surgery performed through a single incision?

Natural orifice transluminal endoscopic surgery

One port umbilical surgery

Minimal access surgery

Single incision laparoscopic surgery (correct)

What is a potential disadvantage of minimally invasive surgery for hospitals?

High costs of equipment and supplies (correct)

Requirement for larger surgical teams

Increased surgical complications

Longer patient recovery times

What does pneumoperitoneum refer to in the context of minimally invasive surgery?

Inflation of the abdominal cavity with gas Signup and view all the answers

Which benefit do patients typically experience following minimally invasive surgery?

Shortened recovery times Signup and view all the answers

What is the main function of the laparoscope in minimally invasive surgery?

To provide illumination and transmit images Signup and view all the answers

What is a consideration the nursing team must have when preparing for minimally invasive surgery?

Ability to convert to an open procedure if necessary Signup and view all the answers

Which of these is NOT considered an advantage of minimally invasive surgery?

Higher costs associated with extended hospital stays Signup and view all the answers

What is the preferred gas used to achieve pneumoperitoneum?

Carbon dioxide (CO2) Signup and view all the answers

What is the desired intra-abdominal pressure range for laparoscopic procedures?

14 to 16 mm Hg Signup and view all the answers

What is the primary function of a trocar system in endoscopic procedures?

To allow insertion and removal of instruments Signup and view all the answers

Which method for creating pneumoperitoneum utilizes the Verres needle?

Closed method Signup and view all the answers

Which type of trocar is most commonly used and requires disassembly for processing?

Hassan trocar Signup and view all the answers

What can result from administering an insufficient amount of CO2 during the insufflation process?

Piercing of the bowel or other vital organs Signup and view all the answers

What distinguishes disposable from non-disposable clip appliers in endoscopic procedures?

Non-disposable clip appliers do not require loading of clips Signup and view all the answers

Why is carbon dioxide chosen over simple room air for pneumoperitoneum?

Air can cause a fire with electrocautery Signup and view all the answers

What is the main purpose of using endoscopes in surgical procedures?

To visualize internal organs and structures Signup and view all the answers

What is the role of an insufflator in laparoscopic procedures?

To indicate the rate of flow and volume delivered Signup and view all the answers

Which method is commonly used to create a pneumoperitoneum during minimally invasive surgery?

Insufflating the abdomen with carbon dioxide Signup and view all the answers

What can excessive intra-abdominal pressure lead to during laparoscopic surgery?

Carbon dioxide diffusion into the blood Signup and view all the answers

What is the role of the endocatch instrument during endoscopic surgery?

To retrieve possibly contaminated specimens Signup and view all the answers

Which factor can increase intra-abdominal pressure during surgery?

Use of argon beam coagulator Signup and view all the answers

What must the nursing team prepare before minimally invasive surgery?

Open instrumentation for conversion if necessary Signup and view all the answers

Endoscopic sutures are referred to by which term?

Loop ligatures Signup and view all the answers

Study Notes

Minimally Invasive Surgery (MIS) Overview

Minimally Invasive Surgery (MIS) involves procedures performed using technology like a laparoscope, reducing the need for large incisions.
Terms like endoscopic, laparoscopic, and minimally invasive surgery are often used interchangeably.

Key Terminology

MAS/MIS: Minimal Access Surgery / Minimally Invasive Surgery.
SPA: Single Puncture Access.
SILS: Single Incision Laparoscopic Surgery.
NOTES: Natural Orifice Transluminal Endoscopic Surgery.

Advantages of MIS

Patients benefit from shorter hospital stays and quicker recovery times.
Leads to reduced postoperative pain and fewer complications (e.g., wound infections, scarring, adhesions).
Hospitals can lower costs linked to shorter stays and decreased infection rates.

Disadvantages of MIS

High costs associated with specialized equipment and supplies.
Procedures are technically demanding, requiring skilled nursing staff familiar with MIS instruments and safety protocols.
Preparedness for potential conversion to open surgery is essential.

Endoscopic Instrumentation

Laparoscopic instruments share names with open surgery tools (e.g., Babcock, scissors) but feature a long shaft.
Endoscope: An instrument inserted through a tiny incision or natural orifice, facilitating internal visualization.
Trocar System: Consists of an obturator and sleeve (cannula) for instrument insertion; includes disposable and reusable options.

Surgical Tools and Equipment

Clip Appliers: Used to secure vessels without suturing; available in disposable and reusable versions.
Suture Types: Loop ligatures, extracorporeal, and intracorporeal sutures are used in surgeries.
Endocatch Instrument: Utilized for retrieving contaminated specimens.
Camera: A non-sterile device requiring sterile draping for visualization.

Pneumoperitoneum

Pneumoperitoneum involves inflating the abdominal cavity with CO2 using an insufflator.
CO2 is preferred due to rapid absorption and safety; it prevents combustion risks associated with room air.
The pneumoperitoneum can be achieved via closed method (Verres needle) or open method (Hassan Trocar).

Insufflation Process

Insufflation separates organs, minimizing the risk of tissue perforation.
Insufflator systems monitor the flow rate (up to 15-20 L/min) and volume (2.5-4 L, adjusted for patient size).
Desired intra-abdominal pressure for laparoscopic procedures is 14-16 mmHg.

Safety Considerations

Overpressure can lead to gas embolus and complications like hypercarbia or respiratory acidosis.
End-tidal CO2 monitoring detects excess CO2 absorption.
Factors increasing pressure include external abdominal pressure and additional gas sources (e.g., argon beam coagulator).

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Description

This quiz focuses on the key concepts of minimally invasive surgery as outlined in Alexander’s Care of the Patient in Surgery and the ORNAC Standards for 2023. Test your knowledge on endoscopic surgery, instrumentation, and important surgical techniques. Prepare to understand the practical applications and terminologies in this essential field of surgery.