Laparoscopy, C37 P223-226 Flashcards Preview

Section II General Surgery P203Surgical Recall Sixth > Laparoscopy, C37 P223-226 > Flashcards

Flashcards in Laparoscopy, C37 P223-226 Deck (22):
1

What is laparoscopy?
P223

Minimally invasive surgical technique
using gas to insufflate the peritoneum
and instruments manipulated through
ports introduced through small incisions
with video camera guidance

2

What gas is used and why?
P223

CO(2) because of better solubility in blood
and, thus, less risk of gas embolism;
noncombustible

3

Which operations are
performed with the
laparoscope?
P223

Frequently—cholecystectomy;
appendectomy; inguinal hernia
repair; ventral hernia repair, Nissen
fundoplication
Infrequently—bowel resection,
colostomy, surgery for PUD (PGV,
perforation), colectomy, splenectomy,
adrenalectomy

4

What are the
contraindications?
P224

Absolute—hypovolemic shock, severe
cardiac decompensation
Relative—extensive intraperitoneal
adhesions, diaphragmatic hernia, COPD

5

What are the associated
complications?
P224

Pneumothorax, bleeding, perforating
injuries, infection, intestinal injuries,
solid organ injury, major vascular injury,
CO2 embolus, bladder injury, hernia at
larger trocar sites, DVT

6

What are the classic findings
with a CO(2) gas embolus?
P224

Triad:
1. Hypotension
2. Decreased end tidal CO(2) (low flow
to lung)
3. Mill-wheel murmur

7

What prophylactic measure
should every patient get
when they are going to have
a laparoscopic procedure?
P224

SCD boots—Sequential Compression
Device (and most add an OGT to
decompress the stomach; Foley catheter
is usually used for pelvic procedures)

8

What are the
cardiovascular effects of a
pneumoperitoneum?
P224

Increased afterload and decreased
preload (but the CVP and PCWP are
deceivingly elevated!)

9

What is the effect of CO(2)
insufflation on end tidal
CO(2) levels?
P224

Increased as a result of absorption of
CO(2) into the bloodstream; the body
compensates with increased ventilation
and blows the extra CO(2) off and thus
there is no acidosis

10

What are the advantages
over laparotomy?
P224

Shorter hospitalization, less pain and
scarring, lower cost, decreased ileus

11

What is the Veress needle?
P224

Needle with spring-loaded, retractable,
blunt inner-protective tube that
protrudes from the needle end when it
enters peritoneal cavity; used for blind
entrance and then insufflation of CO(2)
through the Veress needle

12

How can it be verified that
the Veress needle is in the
peritoneum?
P224

Syringe of saline; saline should flow freely
without pressure through the needle
“drop test”

13

If the Veress needle is not in
the peritoneal cavity, what
happens to the CO(2) flow/
pressure?
P225

Flow decreases and pressure is high

14

What is the Hasson technique?
P225

No Veress needle—cut down and place
trocar under direct visualization

15

What is the cause of postlaparoscopic
shoulder pain?
P225

Referred pain from CO(2) on diaphragm
and diaphragm stretch

16

What is a laparoscopicassisted
procedure?
P225

Laparoscopic dissection; then, part of the
procedure is performed through an open
incision

17

What is FRED®?
P225

Fog Reduction Elimination Device:
sponge with antifog solution used to coat
the camera lens

18

Give some tips for “driving”
the camera during
laparoscopy.
P225

1. Keep the camera centered on the
action
2. Watch all trocars as they enter the
peritoneal cavity (and the tissues
beyond, so they can be avoided!)
3. Watch all instruments as they come
through the trocars (unless directed
otherwise)
4. Ask if you want to come out and
clean and re-FRED the lens
5. Look outside the body at the trocars
and instrument angles to reorient
yourself
6. Keep the camera oriented at all
times (i.e., up and down); usually the
camera cord is on the bottom of the
camera—orient yourself to the camera
before entering the abdomen
7. You may clean the camera lens at
times by lightly touching the lens to
the liver or peritoneum
8. Never let the camera lens come into
contact with the bowel because the
camera may get very hot and you can
burn a hole in the bowel or burn the
drapes!
9. Put your helmet on (i.e., expect to
get yelled at!)
10. Never act agitated when the surgeons
are a little abrupt (e.g., “Center—
center the camera!”)
11. Always watch the trocars as they are
removed from the abdominal wall
for bleeding from the site and view
the layers of the abdominal wall,
looking for bleeding as you pull the
camera trocar out at the end of the
case

19

At what length must you
close trocar sites?
P226

> 5 mm should be closed

20

How do you get the spleen
out through a trocar site after
a laparoscopic splenectomy?
P226

Morcellation in a bag, then remove
piecemeal

21

What is an IOC?
P226

IntraOperative Cholangiogram (done
during a lap chole to evaluate the
common bile duct anatomy and to look
for any retained duct stone)

22

What is the safest time for
laparoscopy during
pregnancy?
P226

Second trimester