Chapter 24: Fundamentals of Laparoscopy and Thoracoscopy Flashcards

1
Q

What benefits have been shown regarding minimally invasive surgical procedures?

A
  • Decrease in pain
  • More rapid return to normal activity
  • Lower incidence of incisional infection
  • Decreased surgical time
  • Shorter hospitalization times
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2
Q

What are the basic components of an endoscopy tower?

A
  • Monitor
  • Camera control box
  • Light source
  • Insufflators
  • Data recording devices
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3
Q

What are they typical light sources?

A
  • Halogen or xenon
  • Xenon is preferred - more closely resembles natural light
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4
Q

What pressure of intrathoracic insufflation causes significant cardiorespiratory depression?

A

3mmHg
- Often not required, placement of cannulas forms a pneumothorax and ribs prevent collapse

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5
Q

What are the recommended insufflation pressures in the abdomen of dogs and cats?

A
  • Dogs: 8-10mmHg (Can increase to 15 with acceptable cardiorespiratory depression)
  • Cats: 8mmHg (little increase in working volume above this)
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6
Q

What is the main gas used for insufflation and why?
How does retrograde flow occur?

A

CO2
- Does not support combustion
- Cheap
- Colorless
- Rapidly excreted
- Highly soluble (unlikely to form gas embolus)

Retrograde flow can occur when the CO2 canister is depleted intra-op and pressure in the body cavity drives air/fluid in a retrograde manner. Can result in damage to equipment and cross contamination of next patient. (Use a filter line)

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7
Q

What is the most versatile telescope for use in vet med?

A

5mm telescope 29cm in length
0 degress is typically used in the abdomen with 30 degree typically used for thorax

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8
Q

What are the benefits of using a cannula?

A
  • Atraumatic repeated instrument exchange
  • Airtight seal for insufflation
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9
Q

What are the disadvantages of reusable cannulas as apposed to single use cannulas?

A
  • Heavy weight
  • Can become dull over time
  • Changing instruments is cumbersome (reducer caps required)

Main benefit is cost reduction

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10
Q

List some types of single-port surgery devices (4)?

A
  • SILS port (single-incision laparoscopic surgery)
  • Triport
  • Gelport
  • Endocone

Most incorporate 3-5 ports within a single device

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11
Q

What size instruments are typically used? What sizes are available?

A
  • Typically use 5mm instruments in vet med
  • 2, 3 and 10mm also available
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12
Q

What instruments are requires for basic laparoscopic procedures?
What other insrtuments are commonly useful?

A

Basic Instruments:
- Metzembaums
- Hook (suture) scissors
- Kelly haemostats
- Babcock forceps
- Cup biopsy forceps

Other useful instruments:
- Right angle forceps
- Knot-pusher (extracorporeal knot tying)
- Fan retractors and inflatable retractors
- Laparoscopic needle holders (parrot jaw most common)

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13
Q

What options are there for laparoscopic/thoracoscopic hemostasis?

A
  • Hemostatic agents (gelfoam, ORC, fibrin glue)
  • Hemostatic clips
  • Suturing (extracorporeal, intracorporeal)
  • Electrosurgery (bipolar is safer)
  • Vessel sealing devices
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14
Q

What is the strongest slip knot for extracorporeal suturing?

A

4S modified Roeder knot

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15
Q

What are the options for laparoscopic vessel sealing devices?
What size vessels can then be used on?

A
  • ForceTriad - up to 7mm (new generation LigaSure)
  • Enseal - up to 7mm
  • Harmonic system - up to 5mm

Voltage for devices = current x resistance (I x R)

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16
Q

When are specimen retrieval bags indicated?

A

When removing tissue that could be neoplastic or infected through a small port incision

17
Q

What size is the most common endoscopic stapler and how many staple rows do they produce?

What sizes endoGIA are available?

A
  • Most commonly 12mm in diameter (require 12mm cannula) and combine 2 triple rows of staggered staples separated by a cutting blade.
  • EndoGIA come in lengths of 30, 45 and 60mm with staple lengths of 2.0, 2.5, 3.5 and 4.8mm (Most common 30-60 length with 3.5mm staples)
18
Q

What are the two techniques for gaining access into the abdominal cavity?

A
  • Veress needle technique - Has a spring-loaded blunt-tipped obturator. Hanging-drop test will confirm when in peritoneal cavity. Once insufflated, veress needle is removed and a sharp trocar-cannula can be placed
  • Modified Hasson technique - A small approach to the linea just caudal to the umbilicus for controlled incision and placement of trocar-cannula. Blunt-tipped trocar used
19
Q

What is this instrument?

A

Veress needle

20
Q

What 2 options are available to gain access to the thoracic cavity?
What is the preferred method of increasing exposure in the thoracic cavity?

A

Gaining access:
- Veress needle
- Cannula without a diaphragm

One-lung ventilation preferred for increasing exposure, insufflation not well tolerated

21
Q

What techniques can be used to create one-lung ventilation?

A
  • Selective intubation
  • Bronchial blockers
  • Double-lumen endobronchial intubation
22
Q

What process limits the physiological effects of V/Q mismatch with 1-lung ventilation?

A

Hypoxic pulmonary vasoconstriction - limits perfusion to non-ventilated lung

23
Q

What procedures have been performed with the use of one-lung ventilation?

A
  • Pericardial windows
  • Subphrenic pericardiectomy
  • Lung lobectomy
  • Thymoma excision