Laparoscopy Lecture Powerpoint

Question 1

Laparoscopic surgery

Answer 1

Surgical technique in which operations are performed thru small incisions and placement of trocars (holes) where a viewing tube and instruments are inserted, it has a camera that transmits the image to monitors and allows a surgeon to perform an operation

Question 2

Insufflation

Answer 2

Blowing air gas or powder into a cavity of body, can be done for abdomen or chest, often done to achieve necessary work space for laproscopic surgery, device responds dynamically to ensure CO2 level (used because it does not distort image and is absorbed more quickly than air) remains at 10-15mmHg

Question 3

Most common complaint after laparoscopic surgery

Answer 3

Referred shoulder pain from irritation of phrenic nerve

Question 4

Trochar

Answer 4

A device that acts as a portal for instruments to gain access to the peritoneal cavity without loss of pneumoperitoneum (air in the cavity)

Question 5

Electrocautery

Answer 5

Process in which direct current is passed thru resistant metal wire electrode generating heat, can be monopolar or bipolar (like tweezers) applied to living tissue to achieve hemostasis or varying degrees of tissue destruction, current does not enter patient body, only heated wire comes in contact with tissue, monoppolar easy to use and good dissecting capabilities but can cause large volume of tissue injury and interfere with pacemakers, bipolar harder to use and has no dissecting capability, but have smaller volume of tissues injured and is safe with pacemaker

Question 6

Direct couplling

Answer 6

Complication of electrocautery where a burn occurs due to faulty insulation or accidental contact with noninsulated tools

Question 7

Benefits of laparoscopic surgery (6)

Answer 7

• pulmonary function maintained better
• less acute phase stress response than open
• less inflammation
• decreased intra-abdominal adhesions compared to open
• quicker GI tract recovery
• decrease and smaller and more aesthetic incisions

Question 8

Negative effects of pneumoperitoneum

Answer 8

• pressure on the cardiovascular system inferior vena cava due to inflation (tachycardia)
• hypercarbia or acidosis
• decreased lung volumes and compliance potentially resulting in atelectasis

Question 9

Reverse trendelenberg position

Answer 9

Patient head above feet, results in pooling of blood, decreased venous return, decreased preload, but increased pulmonary function

Question 10

Trendelenberg position

Answer 10

Patients feet higher than head, sees increased preload due to increased venous return but can see decreased pulmonary functioning

Question 11

Contraindications to laparoscopic surgery (6)

Answer 11

• previous open operation
• intraperitoneal mesh
• cirrhosis and portal hypertension
• COPD or pickwickian syndrome
• hemorrhagic shock
• acute brain injury (trendelenberg can increase ICP)

Question 12

Can laparoscopic surgery be done in pregnancy?

Answer 12

Yes, second trimester is best and good to use lowest possible pressure to avoid fetal acidosis and intra operative fetal monitoring is required

Question 13

Natural oriface transluminal endoscopic surgery

Answer 13

Novel technique to use openings of the mouth or vagina to remove organs such as during cholycystectomy or appendectomy