What is endoscopic surgery?
Minimally invasive surgery
- small incisions
- computer assisted
- digitak imaging/data
Endoscopes can be rigid or flexible for visualizing the interior of a hollow organ or part for diagnostics and surgical purposes
Has channels to enable passage of instruments
Benefits to endoscopic surgery?
Decrease risk of SSI Fast recovery Decrease post op pain Decrease tissue trauma Decrease blood loss Short stays Decrease adhesions
Bioburden?
The number of viable organisms contaminating an object
Biofilm?
Accumulated biomass of bacertia and extra cellular material that is tightly adhered to a surface
Difficult to remove
What is borescope?
A device used to inspect the inside of an instrument through a small opening or lumen of the instrument
What is extravasation?
To pass by infiltration of effusion from a vessel or channel into surrounding tissue
Edema, abd distension, intra abd compartment syndrome
High level disinfection?
Processes that kill all microbial pathogens but not necessarily all bacterial spores
What is insufflation?
The act of blowing gas into a cavity for the purpose of visual examination
What is larparoscopic surgery?
Minimally invasive surgery
- port site
- instruments inserted to perform surgery
Laparoscope is inserted through an incision in abdominal wall and used to visually examine the interior of peritoneal cavity
What is a mechanical processor?
Mechanically cleans, rinses and exposes flexible endoscopes and accessories to a high level disinfectant or liquid chemical sterilant
What is covered under minimally invasive surgery?
Surgeries performed one or more small incisions Radiographic and MRI Computer assisted devices Robotics And other technologies
What is a port site?
A small incision that a trocar is inserted for placement of cannula into a body cavity or body part
What is pneumoperitoneum?
The presence of air or gas within the peritoneal cavity of abd
What is a no fly zone?
Area for safe use of imaging and other equipment
No staff should in area
Safety precaution
What is sterilization?
Processes by which all microbial life are killed
Pathogenic, nonpathogenic and spores
What do video towers contain?
Video monitor Light source Camera control Suction or insufflation Suction irrigation system Esu Gas cylinders Devices for recording
What does white balance do?
Adjusts white, red, green and blue colours to appear as natural as possible
Hold camera 2 inch away from surface and press white balance button
Recording systems for endoscopes?
Must follow HIPPA for storage
Can take pics, store data and print/transfer data
What is an endoscope?
A tube inserted into a natural body orifice or through a small incision to access organs/structures
Rigid or flexible
Surgical or diagnostic
External light for endoscopic surgery?
Requires to visualize
Fiberoptic light = ignition source
*fire safety
Components: light source, cable with light at end and inserted into channel
Fire safety for light source?
No contact with pstient skin or flammable material
Do not rest on drapes
Turn off or place in standby
What are trocars?
Access operative site
Consists of:
obturator - sits inside cannula snd created orifice and removed
Cannula - hollow cylinder that surgical instruments are places through
What are dissecting instruments?
Scissors
- blunt or sharp
- straight or curved
- may connect to ESU to coag
- round tip to dissect w/o truma
Maryland
- seperare/divides tissue
- different shapes to spread, divide, grasp, retract, coag
Clamping instruments?
Dolphin grasper
Toothed grasper
Cup forceps
- traumatic = teeth
- atraumatic = smooth, serrated jaw
- biopsy = used for tissue collection
Suturing/stapling instruments?
Hold and secure
Needle holder
Clip applier
Surgical stapler
What is insufflation gases?
During laproscopic surgery gas in inserted into peritoneal cavity to create pneumoperitoneum
- working space
Most common insufflation gas?
CO2
- easily dissolved
- colourless
- odourless
- cheap
- non flammable
Examples of insufflation gases?
CO2 - most common Air - not easily absorbed Nitrogen Nitrous oxide Argon - depresses hemodynamics conpared to CO2 Helium - less soluable compared to CO2
Potential complicationsof gas insufflation?
Increase BP Cardiac arrhythmias Decreased cardiac output Acidosis Gas embolism Hypercarbia Decreased bloodflow to kidneys Peritoneal irritation Decrease urine output
Safety considerations for gas insufflation?
Place insufflator above level of surgical cavity
Hydrophobic filter is placed between insufflator and tubing
Flush with gas before connecting to cannula
Alarms audible
How should insufflation gas pressure be set?
Lowest level necessary to maintain pneumoperitoneum for adequate visibility
Normally < 15mmHg
Intra abd gas embolism?
Increased abd pressure
Open blood vessels allow gas to enter circulatory system
S&S:
- hypotension
- dyspnea
- cyanosis
- cardiac anomalies
What to do if Intra abd gas embolism occurs?
D/c gas D/c anestheic agents Trendelenburg or left lateral position IV fluids Meds to improve pulmonary circulation CPR
Gas cylinder safety considerations?
Correct gas
- label
- connector
- colour coding
Enough gas in cylinder
Correct key
Cylinders in open position
Second cylinder readily available
What is irrigation and distension media?
Fluids are instilled bu gravity or by infusion pump into body cavity or joint space
Selected by:
- type of procedure
- pt assessment
- instruments to be used
What is intravasation?
When irrigation or distension fluids are abdorbed into pt blood stream
- hyponatremia, hypervolemia, cardiovascular/pulmonary complications
- transurethral resection syndrome
Low viscosity non electrolyte fluids?
Used for monopolar
Hypotonic
Cause cause TUR syndrome
Ex:
1.5% glycine, 5% mannitol, 3% sobitol
NS fluids?
Common with bipolar
Isotonic
Contains electrolytes
Safer if absorbed
High viscosity fluid?
Plasma volume explander
- can draw 6x its own vojnd into bloodstream
Provides good visibilty when bleeding occurs
Contains glucose content
Can cause significant complication
- fluid overload, heart failure, pulm edema
Needs fo be rinsed/flushed with sterile water after use
Ex. Dextran
Preventing thermal injuries from fluids?
Store as per manufacturer instructions
Keep seperate from blankets
Label irrigation fluids with date that it was put in warmer and expiration date
Patient considerations for laparoscopic sx?
Previois incision - trocar insertion Hx of DVT - positioning decreases venous return Consent - may need to open Voiding prior to sx - helps avoiding puncturing with trocar
