L20: Minimally Invasive Surgery (Case) Flashcards Preview

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Flashcards in L20: Minimally Invasive Surgery (Case) Deck (31):
1

Minimally Invasive Surgery (MIS)

any surgery that is less invasive and/or results in less tissue trauma compared to open surgery
-usually performed w/ telescope and camera
-aka band-aid or keyhole surgery

2

laparoscopy

endoscopy in the abd

3

thoracoscopy

endoscopy in the thorax

4

Veress needle

a spring-loaded needle used to create pneumoperitoneum for laparoscopic surgery

5

Trocar

Composed of obturator (sharp or blunt) and cannula (smooth or threaded)

6

cannula

outer part of trocar that stays in abdomen once you take trocar out
-smooth or threaded
-threaded screws in, has tighter seal, and has rubber reducer valves for insufflation or no insufflation w/ one way valve

7

"the tower"

houses light source, video control unit, insufflator (CO2 gas; air would cause embolism or can combust)
-insufflator keeps abdomen distended and controls flow rate and maximum pressure

8

rule of triangulation

camera closest to you, then instruments, then monitor in a triangle

9

use what size telescope most commonly?

5mm

10

bipolar cautery

-can be used to easily ligate vessels up to 7mm, ovarian pedicle, etc.

11

forceps used

Babcock
Scissor
Kelly

12

methods of sterilization

1) Gas (ethylene oxide or gas plasma; preferred for scopes, cameras, cables)
2) Steam sterilization (gravity dependent; ok for scopes/cameras/cables but reduces their life)
3) Cold sterilization (2% glutaraldehyde; use to sterilize scopes between procedures)

13

Indications for laparoscopy

-elective procedures: OVE, gastropexy, cryptorchidectomy, biopsy
-client request
-patient morbidity (less pain, hospitalization, medication, infection)
-hospital reputation

14

contraindications of laparoscopy

-inexperienced surgeon or staff
-missing instrumentation (ie. bipolar cautery)
-advanced and exploratory procedures (GI, cholecystectomy, adrenalectomy)

15

physiologic effects of abdominal insufflation***

pressure against diaphragm and vena cava --> dec. thoracic compliance and venous return --> dec. tidal volume, CO --> hypoventilation, hypoxemia, acidemia
***SOLUTION: limit intra-abdominal pressure and duration. Dogs: <8mmHg***

16

sources of pain: Incisions

tissue injury: cutaneous and muscular nerve endings - nociceptors
tx/prevent: limit incision size and number. Give local anesthetic and NSAIDs; block nerve conduction

17

sources of pain: peritoneal CO2

CO2 + H2O = carbonic acid --> acidosis --> chemical irritation of peritoneum
nonhumidified --> dessication of peritoneum
tx/prevent: evacuate residual gas, use humidified gas

18

sources of pain: stretching of diaphragm

neuropraxia (disorder of the peripheral nervous system in which there is a temporary loss of motor and sensory function due to blockage of nerve conduction)
-can affect phrenic nerves, visceral afferents

tx/prevent: limit insufflation pressure (dogs <8), limit duration of sx

19

surgical costs -->

anesthesia
instrumentation
procedure
technical

20

hospital costs -->

level of care
duration
medications

21

total costs -->

neuropraxia: phrenic nerves, visceral afferents

22

convert what percent of diagnostic laparoscopic cases to laparotomy?

20%

23

complications of Lap-OVE

-splenic laceration/hemorrhage (ace makes spleen enlarge)
-pedicle hemorrhage (usually only a problem if using old cautery)
-SC emphysema
-loss of insufflation due to slipped cannula or enlarged incision
-dropped ovary or pedicle
*conversion is NOT a complication!*

24

surgical complications of OVH or OVE

-post-op hemorrhage or ovarian a, uterine a., or broad ligament
-ureteral ligation
-Ovarian Remnant Syndrome (70% on R side; prevent with better incision location)

25

long-term complications of OVH or OVE

-uterine neoplasia: 0.03% risk, 0.003% risk malignant; uterine stump leiomyosarcoma just as likely!
-endometritis/pyometra: 15-25% risk by 10yrs. Requires functional ovarian tissue. Disease of luteal phase (diestrus)

26

see graph slide 8***

:)

27

evidence for OVE over OVH

-easier
-fewer complications
-less tissue trauma
-less painful
-faster
-minimally invasive*

28

indications for prophylactic gastropexy

-relative with GDV
-large breed and deep chest
-Great Danes have 40% lifetime risk
-Irish Wolfhound, Standard Poodle

29

surgical options for prophylactic gastropexy

-open
-keyhole
-laparoscopic
-lap-assisted

30

SILS =

single incision laparoscopic surgery

31

complications of lap-gastropexy

-seroma (very common)
-splenic laceration/hemorrhage
-serosal tearing
-loss of insufflation due to enlarged incision
-dropped stomach
-conversion to keyhole technique possible