Minimal Invasive surgery

Question 1

The most common arrythmia seen durring laparoscopy is ______

Answer 1

Sinus bradycardia

• A rapid stretch of the peritoneal membrane often cause a vagovagal response with bradycardia and occasionally hypotension
• Management
  
  • desuflation of the abdomen
  • administration of vagolytic agents
  • adequate volume replacement
• In hypovolemic individual, excessive pressure on theIVC and reverese trendelenburg with loss of lower extremity muscle tone may cause decreased venous return and cardiac output

Question 2

Capacitive coupling

Answer 2

Results when when energy bleeds from a port sleeve or laparosope into adjacent (but not touching) bowel

• capacitive coupling occurs when a plastic trocar insulates the abdominal wall from current; in turn the current is bled off a metal sleeve or laparoscope into the viscera
• May result in thermal necrosis and a delayed fecal fistula

Question 3

True regarding safe laparoscopic surgery in pregancy

Answer 3

• The patien should be in left lateral position
• Open abdominal access (Hasson) is recommended versus direct puncture laparoscopy (Veress needle)
• The surgery should be performed during the second trimester if possible
• sequential compression devices are essential for all procedures
• Protection of the fetus against intraoperative X-rays is imperative

Question 4

Systemic effects of CO2 from pneumoperitoneum

Answer 4

• Hypercabia
  
  • anesth can increase ventilatory rate ir vital capacity
    
    • If RR>20 = less efficient gas exchange
    • Increase vital capacity = barotrauma
  • can cause tachycardia and increased systemic vascular resistance, which elevates blood pressure and increase myocardial oxygen demand
• Increased myocardial oxygen demand
• increased afterload

Question 5

when performing alaparasocopic Nissen fundoplication during transhiatal dissection the mediastinal pleura is compromised and a CO2 pneumothorax develops, Whta is the initial preferred management of the pneumothorax

Answer 5

Enlargement of the defect and placement of an 18-French red rubber catheter across the defect with multiple holes cut out of the distal end across the defect

at the end of the procedure, the distal end of the tube is pulled out 10-mm port side (as port is removed), and the pneumothorax is evacuated to a primitive water-seal using a bowl of setile water or saline

Question 6

advantages of computer-enhanced surgery comapred to traditional laparoscopic surgery

Answer 6

• Natural wrist movements and improved manual dexterity
• Ergonomically comfortable workstation with 3D imaging
• Tremor elimination
• features a second console slave enabling greater assisting ang teaching opportunities

Question 7

A patient undergoing laparoscopic resection is noted to have decreaed urine output during the last hour of the case. A bolus is given at the end of the case. One hour later, there is still very poor urine output. The appropriate treatment

Answer 7

None of the above

• Low urine output is a normal physiologic response to increased intra-abdominal pressure for up to 1 hour after surgery
• hormonally mediated changes such as elevated ADH levels decrease urine output for up to 1 hour after the procedure has ended.
• IV fluid administration during an uncomplicated laparoscopic procedure should not be linked to urine output