Minimally Invasive Surgery (MIS) PDF

Minimally Invasive Surgery (MIS)  Learning Outcomes ▪ Define the term endoscopic surgery. ▪ Describe the function and usage of common endoscopic instrumentation. ▪ Understand pneumoperitoneum and potential complications. ▪ Discuss the process for converting from an MIS ca...

Minimally Invasive Surgery (MIS)  Learning Outcomes ▪ Define the term endoscopic surgery. ▪ Describe the function and usage of common endoscopic instrumentation. ▪ Understand pneumoperitoneum and potential complications. ▪ Discuss the process for converting from an MIS case to an open case.  Definition and Terminology ▪ Surgery that is performed using technology and eliminating the need for a large incision. ▪ Other interchangeable terms for MIS – Endoscopic surgery – Laparoscopic surgery – Minimal access surgery (MAS) – Single puncture access (SPA) – Single port-surgery (SPS) – One port umbilical surgery (OPUS) – Natural orifice transluminal endoscopic surgery (NOTES) MIS Versus Open Surgery  Endoscopic MIS Instrumentation ▪ Endoscopes – Flexible, rigid, or semirigid – Diagnostic or operative – Fiberoptic or videoscope ▪ Light Sources and Fiberoptic Cable – Caution used to ensure the ends of cables do not contact patient’s skin or flammable material (drapes) – Light cords should be turned off when disconnected or not in use – White balance required – Contains multiple glass fibers for light transmission – Avoid kinking or dropping  Trocar System ▪ Disposable or re-usable (Hasson Trocar) ▪ Consists of an obturator and a sleeve (cannula) ▪ May be sharp or dull ▪ Provides a mechanism to insert and remove MIS instrumentation ▪ Steps – Obturator and sleeve inserted to access operative site – Obturator removed after port of entry made – Sleeve remains in place – Repeat for additional trocar and puncture sites (if required) Disposable Trocars Systems  Camera ▪ A non-sterile device that connects to the endoscope ▪ The camera must be draped with a sterile camera sleeve by the scrub nurse  MIS Instruments Continued ▪ Clip Applier – Disposable or re-usable ▪ Suturing (Loop ligation) ▪ Endocatch (Retrieval Device ▪ Stapling device * The Nursing team must always prepare open instrumentation for all MIS surgeries in the event of converting to open procedure Grasping & Dissecting Instrumentation  Video Technology Components ▪ Basic standard medical video system – Endoscope – Light cable – Light source – Camera head – Camera cord – Camera-scope coupler (adapter) – Camera control unit – Video monitor – Recording system Robotics  Pneumoperitoneum ▪ Created to visualize abdominal structures and to enhance safety ▪ CO2 delivery using insufflation tubing – Rate 15-20 Liters per min – Volume 2.5 to 4 Litres – Pressure (flow) 14 to 16 mm Hg  Establishing Pneumoperitoneum ▪ Closed Method – Paraumbilical incision – Verres needle inserted into abdomen – Placement confirmed by negative bowel and blood return on aspiration and saline instillation without resistance – Insufflation tubing connected – CO2 gas insufflated  Establishing Pneumoperitoneum ▪ Open Method – Incision made through umbilicus – Peritoneum is incised – Hasson Trocar placed – Stay sutures applied – Insufflation tubing connected – CO2 gas insufflated  Safety Considerations Overpressurization ▪ Increased CO2 insufflation ▪ Leaning on the patient’s abdomen ▪ Adding additional sources of gas – Laser – Argon beam coagulator Causes ▪ Forces CO2 to diffuse into bloodstream, causing hypercarbia ▪ Gastric regurgitation and aspiration of stomach products ▪ Decrease respiratory effort and cardiac output ▪ Increases postop pain the shoulder and neck area  Anesthetic Considerations during MIS ▪ Hypothermia ▪ Hypoxia ▪ Increased peripheral resistance ▪ CO2 gas emboli ▪ Gastric reflux ▪ Subcutaneous emphysema ▪ Pneumoscrotum  References ▪ Rothrock, J. (2022). Alexander’s Care of the Patient in Surgery (17th ed.) Mosby Elsevier. ▪ Tighe. S. (2015) Instrumentation for the Operating Room (9th ed.) Mosby. ▪ ORNAC Standards 2023