MIS basics
Most common gas used in laparoscopy and 3 reasons why?
CO2; non-flammable, absorbed by the body (lower likelihood of gas embolus), inexpensive
Two absolute contraindications to MIS?
Hypovolemic shock (or severe hemodynamic instability) and lack of MIS skills
Drying time for alcohol-based skin prep (on shaved skin)?
3 minutes
Goal pneumoperitoneum pressure?
15mmHg
List 3 advantages/benefits to using the robot?
Possibly reduced operative time, increased maneuverability, tremor elimination, better visual control of operative field, enhanced suturing, improved ergonomics, instrument articulation, shortened learning curve
What are two ways to improve surgeon ergonomics?
Monitors at eye level, elbows flexed between 60-120 degrees, arms minimally abducted
MIS is safe for pregnant patients in which trimester(s)?
All
Which type of surgical energy device uses the most energy?
Monopolar instruments (10x more than bipolar or ultrasonic)
Two ways of confirming correct veress needle insertion?
Two audible clicks, loss of resistance with insertion, no blood or enteric contents on aspiration, saline drop test
What are the three main components of the robotic surgery setup?
Surgeon console, patient cart, vision cart
Laparoscopes are available in what angles?
0 degrees, 30 degrees, and 45 degrees
Bradycardia upon insufflation occurs as a ________ response; how should it be addressed?
What is the maximum size vessel that is sealable by bipolar devices?
7mm
Define palmer's point?
Left midclavicular line, 3cm below costal margin
What size(s) do the robotic endoscopes come in?
8mm and 12mm
What is the cause of a foggy image?
Differences in temperature and humidity between the room and the body cavity
Two trocar-related considerations in obese patients?
May need longer trocars, thicker abdominal wall may decrease the mobility of the trocar
Which type(s) of energy device require(s) ancillary cutting mechanisms?
Bipolar only
What are two ways extraperitoneal gas extravasation may present?
Delayed hypercarbia, gas embolus, subcutaneous emphysema
List 3 disadvantages/limitations to using the robot?
Narrow operative field, lack of tactile feedback, need for an experienced bedside assistant, no specific guidelines for credentialing
What are five reasons for poor insufflation or loss of pneumoperitoneum?
CO2 tank empty, accessory port stopcock open, leak, excessive suctioning, disconnected insufflation tubing, hasson stay sutures loose, CO2 flow rate set too low, valve on CO2 tank not fully open, leak at skin around port
Name one problem caused by long-standing peritonitis (in the context of MIS)?
Increased risk of injury or decreased exposure
Duty cycle percentage of cut vs. coag?
Cut: 100%; coag: 5%
What are the steps of the Hasson technique?
Make a periumbilical incision, elevate the base of the umbilicus, incise the linea alba, place anchoring sutures, insert a trocar under direct visualization, anchor sutures to the trocar
What year was the first robotic cholecystectomy performed?
1997