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Details

LAPAROSCOPY/ROBOTICS
LAPAROSCOPY/ROBOTICS
140
Nursing
Graduate
06/26/2011

Additional Nursing Flashcards

 


 

Cards

Term
What are the frequently performed laparoscopic procedures for GYN surgeries? (4)
Definition

Lap BTL - bilateral tubal ligation

Diagnostic for pelvic pain, infertility, etc

LAVH - lap assisted vaginal hysterectomy

Ectopic pregnancy

 

Term
What are the frequently performed general lap procedures? (6)
Definition

lap choley

lap appy

hiatal hernia

diaphragmatic hernia

lap banding - weight loss

colon, spleen, liver

Term
What are the frequently performed lap GU procedures? (2)
Definition

prostatectomy

HAL nephrectomy 

Hand assisted laparoscopic nephrectomy

Term
What are the frequently performed vascular lap surgeries? (1)
Definition
Abdominal aortic procedures
Term

What are the advantages of laparoscopic surgery? (5)

 

_____ surgical trauma

______ postop pain

improved postop _______ function

_______ hospital stays

earlier return to ______ activities

Definition

minimizes surgical trauma

less postop pain

improved postop pulmonary function

shorter hospital stays

earlier return to normal activities

 

 

*see chart slide 64

Term
What labs are evidence of decreased tissue damage with lap surgery? (2)
Definition

decreases in C-reactive protein

decreases in interleukin-6

 

 

 

(these reflect the extent of tissue damage)

Term
Why does lap surgery have a lower frequency and severity of post-op ileus?
Definition

decreased manipulation of the bowel

minimization of peritoneal incision

Term
Is the hyperglycemic response increased or decreased with laparoscopic surgery compared to laparotomy?
Definition

reduction in hyperglycemic response as compared to laparotomy

 

 

(nitrogen balance and immune fcn might be better preserved as a result)

Term

Is the adrenocortical response decreased with lap surgery?

 

Excretion of ____ and _____ metabolites unchanged from laparotomy.

 

How can intraop stress be decreased?

Definition

No:

no benefit in reduction of adrenocotical response

(adrenocortical response more from visceral nociception than incisional stimulation)

 

excretion of cortisol and catecholamine metabolites unchanged from laparotomy

 

Intraop stress can be decr by giving alpha-2 agonists preop

Term
Is laparoscopic surgery beneficial for reducing post op pain?
Definition

yes

significant reduction in need for post-op analgesics

Term
What is the character of pain with a laparotomy surgery?
Definition
more incisional pain
Term
What is the character of pain with a laparoscopy?
Definition

more visceral pain (spasm)

and

shoulder pain from diaphragmatic irritation

Term
What are 3 techniques used to minimize pain following laparoscopy?
Definition

Pre-operative NSAIDs

intraperitoneal LA

more complete evacuation of pneumoperitoneum


Term
What surgeries are pre-op NSAIDs definitely effective in?
Definition

laparoscopic cholecystectomy

gynecologic laparoscopy other than BTL

Term

When is an intraperitoneal LA beneficial?

 

Conflicting results with _______.

Definition

particularly beneficial in gynecologic procedures

 

conflicting results with lap choley

Term

What type of block is valuable in Lap BTL?

 

When is it more effective?

Definition

Mesosalpinx block

 

more effective if performed at start of procedure rather than end

 

(The mesosalpinx is the part of the broad ligament of the uterus enclosing a fallopian tube)

Term
How do you evacuate the pneumoperitoneum?
Definition

Give a valsalva breath at the end of case, which helps push some air out

 

close APL

give 15-20 cmH2O breath over 8-10 sec

Term
How is pulmonary dysfunction described following laparoscopy compared to laparotomy?
Definition

less severe

&

resolves more quickly

Term
In what 4 types of pts is a greater severity and slower recovery of the pulmonary system reported?
Definition

elderly

obesity

COPD

smokers

Term
What are 3 disadvantages of laparoscopy?
Definition

PONV

2-dimensional image

difficulty in maneuvering instruments

Term
What is the % of PONV with lap?
Definition

40-75% incidence

(high)

Term
What is the primary determinant of length of stay for day surgery patients?
Definition
PONV
Term
What are 4 methods to reduce PONV?
Definition

Propofol anesthesia

Intraop antiemetics - often in combo

Supplemental analgesia to reduce opioid consumption

Emptying stomach intraop (OGT)

Term
What are some controversial methods to reduce PONV?
Definition

Nitrous oxide (Ron says incr PONV)

O2 supplementation in PACU

Term

What positions are used for pelvic & lower GI surgery?

 

Which position predisposes pt to gas emoblism?

Definition

Trendelenburg position,

often accompained by Lithotomy

 

trendelenburg

Term
What position is used for upper GI surgery?
Definition

Reverse Trendelenburg

 

Term
What changes are directly related to steepness of tilt?
Definition
CV and Respiratory changes
Term
What position is usually well tolerated by the patients respiratory system?
Definition
Reverse Trendelenburg (head up)
Term
What does Trendelenburg (head down) position produce on the respiratory system? (3)
Definition

decreased FRC

decreased lung volume

decreased lung compliance

Term
In which type of pts are the respiratory effects of Trendelenburg exacerbated?
Definition

elderly

obese

preexisting pulmonary compromise

Term

What is the effect of laparoscopy on HR caused by?

What are the CV changes related to Trendelenburg?

What 2 mechanisms are activated?

Are these synergistic or antagonistic?

What heart rhythm predominates?

 

Definition

 

A fcn of peritoneal stretch as a result of incr IAP→decr HR 

 

Increased CVP & CO →Baroreceptor Reflex →Systemic Vasodilation and Bradycardia

 

The baroreceptor & atrial stretch reflexes compete against each other, bradycardia predominates.

 

 

Baroreceptor reflex--with incr CVP & CO, inhibit SNS & incr PNS to get back within norm BP

 

Atrial stretch receptors are also activated by incr R sided filling pressures (bainbridge reflex= incr SNS outflow to move blood out of atria, get incr in SNS & decr PNS, which would incr HR & contractility)

 

 

Term
How is the normal heart effected by Trendelenburg position?
Definition
no significant compromise
Term
How does Trendelenburg affect poor ventricular function/CAD?
Definition
increased myocardial oxygen demand may compromise patient
Term
How does Reverse Trendelenburg affect the CV system?
Definition
↓Venous Return →Decreased CO & MAP →Increased SVR →Decreased CO
Term
What CV affects are seen with pneumoperitoneum?
Definition
increased SVR seen with pneumoperitoneum may further decrease CO
Term

What is venous stasis exacerbated by?

 

What type of prophylaxis do we use?

Definition

reverse trendelenburg

pneumoperitoneum

lithotomy

 

pts need SCD

Term

When are nerves more susceptible to injury?

 

What is the primary concern with Trendelenburg position and nerve injuries?

Definition

during stretch or ischemia

 

over-extension of the shoulder

Term
What are the 4 common nerve injuries/problems seen with Lithotomy?
Definition

common peroneal nerve

lateral femoral cutaneous nerve

femoral nerve

compartment syndrome

Term
How does a pneumoperitoneum affect respiratory compliance and FRC?
Definition

~30-50% compliance reduction (depends on IAP & preexisting disease)

FRC decreased secondary to elevated diaphragm

Term

What is there a potential for with a  pneumoperitoneum? (respiratory)

 

We should avoid pressure of _____, particularly w/ _____.

 

If a pt becomes bradycardic as a result of insufflation, what can help?

Definition

potential for V/Q mismatch

 

avoid pressure of >14mmHg particularly with CV compromise

 

slow down rate of gas insertion or decr IAP a little

Term

How does pneumoperitoneum affect PaCO2 in pts under controlled ventilation?

 

When does it plateau?

 

What happens if the PaCO2 keeps incr after this period of time? What could this indicate?

 

Change in PaCO2 depends on increased _____? 

Definition

PaCO2 progressively incr

 

Reaches plateau ~ 15-30 min after beginning of CO2 insufflation

 

Any sig. incr PaCO2 after this period requires a search for a cause such as subQ emphysema, gas embolism, MH

 

incr in PaCO2 depends on IAP

Term
How does pneumoperitoneum affect PETCO2 in pts under controlled ventilation?
Definition

Mimics PaCO2 (but ~4-5 mmHg lower):

 

progressively incr & reaches plateau ~ 15-30 min after beginning of CO2 insufflation in pts under controlled ventilation

Term
How does pneumoperitoneum affect pH in pts under controlled ventilation?
Definition
it progressively decr
Term

How does local anesthesia affect PaCO2?

What is this d/t?

Definition

PaCO2 unchanged due to:

compensatory increase in minute ventilation

Term

GETA with spontaneous ventilation

 

________ PaCO2 despite ____ minute ventilation, due to _____ compliance and ventilatory _______ from anesthetics

 

Don't they compensate?

 

How can CRNA fix this?

Definition

Increased PaCO2 despite increased minute ventilation, due to decreased compliance and ventilatory depression from anesthetics

 

pt tries to compensate, but can't compensate for laparoscopy, pneumoperitoneum & GA all at same time

 

since they are intubated, we can incr MV to blow off CO2

Term
When is a greater change in PaCO2 seen?
Definition
with sicker patients
Term

What are the 2 causes of increased PaCO2 during pneumoperitoneum? Which is the number 1 cause?

 

How do we know that absorption of CO2 is the main reason for the increase in PaCO2 seen with pneumoperitoneum?

Definition

absorption of CO2

(#1 cause)

mechanical causes

 

b/c if do laproscopy with Helium etc there is minimal to no increase in PaO2

(no increase with healthy pts per Ron)

 

Term
What are the mechanical causes of increased PaCO2 during pneumoperitoneum?
Definition

Impaired ventilation and perfusion:

 abdominal distention

 positioning

 inadequate ventilation

-Iatrogenic

-Ventilatory depression with spontaneous respiration

Term
What is the only mechanism of increased PaCO2 from a pneumoperitoneum with healthy, non-obese pts with IAP <10mmHg?
Definition
absorption of CO2
Term

Pts can get increased PaCO2 d/t ventilatory changes and mechanical forces on top of absorption mechanism IF have...(2)

 

What happens as IAP continues to increase?

 

Where do we like to keep the IAP?

Definition

 cardio-respiratory compromise

or IAP >10mmHg

 

 

The vent/mechanical effects play a greater role as IAP increases further

 

 keep IAP ≤14mmHg

(not my job to monitor)

Term
What are 4 respiratory complications of pneumoperitoneum?
Definition

subcutaneous emphysema

pneumothorax (pneumomediastinum, pneumopericardium)

endobronchial intubation

gas embolism

 

 

see chart on slide 32

Term
What is sub q emphysema suggested by?
Definition

an increase in ETCO2 following the inital plateau

(also consider MH with increase in EtCO2)

 

swelling & crepitus

Term
What are the causes of sub q emphysema? (2)
Definition

accidental extraperitoneal insufflation

necessary extraperitoneal insufflation

 

Term
What are examples where extraperitoneal insufflation is needed? (3) 
Definition

inguinal hernia

pelvic lymphadenectomy

hiatal hernia repair

Term
How do we manage sub q emphysema?
Definition

hyperventilation and suspend insufflation/surgery briefly until CO2 blown off

 

continue mechanical ventilation at conclusion of case until ETCO2 returns to normal

Term

What is a capnothorax?

What causes it?

Definition
passage of gas through weak points in diaphragm or at aortic/esohageal hiatus secondary to increased IAP
Term
How do you diagnose a capnothorax? 
Definition

increased airway pressure

increased EtCO2

(CO2 in chest cavity = inc surface area for absorption)

auscultation & CXR

 

reduced air entry

hyperresonance

Term

What is a pneumothorax?

What causes it?

Definition
rupture of pre-existing bullae secondary to increased minute ventilation
Term
How do you diagnose a pneumothorax?
Definition

increased airway pressure

decreased EtCO2

auscultation & CXR

 

 decr air entry

 hyperresonance

Term

How do we manage a CO2 pneumothorax (capnothorax)? (4)

 

 

When and how will it resolve?

Definition

stop N2O if using (just don't use it b/c of increased N/V issues & increase in size of air emboli if occur - per Ron)

adjust vent to correct hypoxemia

PEEP

reduce IAP

 

resolves spontaneously - very highly diffusable

Term
What is the management of ruptured bullae (pneumothorax)?
Definition

thoracentesis

no PEEP

(would just push more air into the thorax)

Term

What is the main difference in diagnosing capnothorax vs pneumothorax?

 

What is a difference in managing these?

Definition

Capnothorax: increased ETCO2 (CO2 in chest cavity) 

Pneumothorax: decreased ETCO2

 

capnothorax: use PEEP

pneumothorax: no PEEP

Term
What is an endobronchial intubation caused by?
Definition
caused by cephalad displacement of diaphragm following insufflation
Term

How do you diagnose an endobronchial intubation?

 

How do you manage this?

Definition

decreased SpO2

increased airway pressure

auscultation (reduced air entry)

 

pull tube back some

Term

When does a gas embolism typically present?

What is it d/t?

Definition

typically presents at the start of insufflation

 

d/t placement of insufflating needle into a blood vessel or organ

Term

Is CO2 soluble in blood?

 

CO2 has a ____ carrying capacity and is ___ eliminated

Definition

yes, very soluble in blood

 

high carrying capacity

rapidly eliminated

 

So absorption issues can resolve quickly etc

Term
What is the lethal dose of CO2?
Definition
~5X that of air
Term
What does a large volume of CO2 in RA or vena cava do?
Definition
obstructs venous return resulting in decreased CO or circulatory collapse
Term

What may a large volume of CO2 in the RA or vena cava result in?

 

In which pts in particular does this happen?

Definition

R→L shunt producing gas embolization of the coronary and cerebral vasculature

 

 particularly with patent foramen ovale

Term

How do we diagnose a gas embolism? (4)

 

What is the definitive diagnosis of a gas embolism?

Definition

decr EtCO2

decr SpO2

tachycardia

hypotension

millwheel murmur

 

aspiration of gas or foamy blood from a central venous line

Term

*List the steps for managment of a gas embolism. (8 total)

 

Step 8 - consider ______ treatment if gas in cerebral circulation

Definition

1. stop insufflation

2. release pneumoperitoneum

3. steep trendelenburg

4. left lateral decubitis

5. stop nitrous oxide

6. 100% oxygen

7. central venous line to aspirate gas

8. consider hyperbaric oxygen treatment if gas in cerebral circulation

Term
Is there an increased risk of aspiration in a lap surgery?
Definition

controversy exists over whether the increased IAP during laparoscopy predisposes the patient to increased aspiration risk

 

may be compensated in some part by increased tone of lower esophageal sphincter

(d/t SNS stimulation with insufflation)

Term
What are the HD affects of pneumoperitoneum in the normal patient?
Definition

minimal to no change in HR

decreased CO -initial 10-30% decrease with insufllation

increased SVR -d/t incr. catecholamines/vasopressin

increased BP -d/t incr SVR

 

 

 

*see chart on slide 41

Term

How much is the CO decreased initially during insufflation?

proportional to?

 

independent of?

Definition

decreased 10-30% initially

proportional to increase in IAP

 

independent of patient positioning

Term
What is the change in CO with pneumoperitoneum related to?
Definition

d/t incr IAP:

increased SVR (SNS)

decreased venous return (compression)

 

Term

What level of IAP causes decreased venous return  to be seen with pneumoperitoneum? How does this occur?

What attenuates the decrease in CO see? (2)

Definition

at IAP>10mmHg

 

increased IAP→caval compression→ ↑venous resistance & pooling of blood in legs

 

attenuated by:

fluid preload

wrapping legs or SCDs

Term

What is the change in SVR with insufflation?

What is this NOT a result of?

Definition

increased SVR

NOT a result of decreased CO

(but rather d/t incr. SNS)

Term
How is the SVR affected by patient position?
Definition

attentuated by trendelenburg

accentuated by reverse trendelenburg

Term
How is increased SVR affected by volume status?
Definition
a fluid load may moderate this effect
Term

How does vol loading affect CI & SVR w/ pneumoperitoneum?

 

Should we always vol load?

Definition

vol loaded pts better able to maintain CI

SVR lower (closer to baseline)

 

yes, vol loading is always important unless there is compelling reason not to

 

 

*see graph slide 37

Term

What causes/mediates increased SVR seen with pneumoperitoneum?

 

What cause the release of these mediators? (2)

Definition

mechanically and neurohumorally mediated:

increased vasopressin, catecholamines

 

increased intrathoracic pressure
stimulation of peritoneal receptors

Term

What is the potential for thromobembolic complications due to?

 

How do we try to prevent this?

 

Is this worse with laparoscopy?

Definition

potential d/t lower limb venous stasis

 

most patients are wearing SCDs

 

no measurable increase seen with laparoscopy in & of itself but positioning plays a big role per Ron

Term

What are the renal changes seen with pneumoperitoneum?

 

How is this fixed?

Definition

~50% reduction in UOP, GFR, & renal blood flow

 

promptly restored when pneumoperitoneum released

Term

How is splanchnic and hepatic blood flow affected?

 

Why?

Definition

appear not to be clinically significant

 

b/c CO2 vasodilates splanchnic vessels = compensates for compression per Ron

Term

How is cerebral blood flow affected?

 

What should we do for pts at risk for complications with increased CBF and ICP?

Definition

increased d/t elevated PaCO2 (vasodilates)

 

maintain normocarbia in pts at risk

Term

How is IOP affected in pts with healthy eyes?

 

What if they have glaucoma?

Definition

no change in absence of pre-existing disease

 

slight increase seen in glaucoma animal model SO DONT USE LAPROSCOPY with GLACOMA PTS

Term
How does pneumoperitoneum affect heart disease patients?
Definition
same pattern as in the normal heart, but more severe changes
Term
What is the worst case scenario for preop patients with heart disease coming for a laproscopic surgery?
Definition

low CO 

decr CVP

high SVR

high MAP

 

*all these issues will become worse with insufflation

Term

How do you manage patients with heart disease going for a laparoscopic surgery?

 

 

Which pts tend to need higher insufflation pressures?

Definition

preop fluid load

slow insufflation with minimum IAP necessary

if needed, a selective arteriorlar dilator

ie Hydrazaline

 

Obese

Term

What is the most common arrhythmia w/ pneumoperitoneum?

 

What is it due to?

Definition

bradycardia


d/t reflex increase of vagal tone from stretch of the peritoneum

 

can also see with traction of fallopian tubes and round ligaments

Term

Bradycardia is more severe with pts on ______?

What can it progress to?

Definition

may be more severe in B-blocked patients

may progress to asystole

Term
What is the treatment of bradycardia? (5)
Definition

1. stop insufflation

2. release pneumoperitoneum if necessary (↓stretch)

3. atropine

4. ACLS as needed

5. less likely to recur with a deeper plane of anesthesia, if tolerated

Term
What are the differential diagnoses for cardiac arrythmias? (3)
Definition

insufflation

underlying cardiac disease/rhythm disturbance

gas embolism

Term
What are the most common surgeries during pregnancy?
Definition

adnexal surgery (ovarian cyst)

appendectomy

cholecystectomy

Term
What are the concerns of surgery during pregnancy? (3)
Definition

simulation of premature labor

damage to gravid uterus

teratogenicity of anesthetic gases

Term
For surgery during pregnancy, why is maintaining the maternal PaCO2 in the normal range a good idea?
Definition
if maternal PaCO2 is maintained in the normal range, placental blood flow, fetal pH, and blood gas tensions are unaffected by insufflation
Term
What is the primary consideration for lap surgery in the pregnant patient?
Definition

Involve the Obstetrician:

timing of procedure

tocolysis

monitoring

Term

What are other considerations for lap surgery in the pregnant patient?

_____ for trocar access

______ load as in others

maintain normal maternal ______

____ ______ displacement

Definition

minilap for trocar access

fluid load as in others

maintain normal maternal EtCO2

left uterine displacement

Term
What are contraindications preop for lap surgery? (3)
Definition

increased ICP

hypovolemia

VP or PJ shunt

 

 

VP=venticularperitoneal

PJ=peritoneojugular

 

(Miller 2195 states that lap can be performed safely in pts w/ VP or PJ shunt w/ unidirectional valve resistant to IAPs used during pneumoperitoneum)

Term
What are the considerations preop for lap surgery? (5)
Definition

heart disease 

renal insufficiency 

DVT prophylaxis 

preop NSAIDs (reduce postop pain & opioid requirements) 

anesthetic adjuncts:

dexmedetomidine

clonidine

(these both decr intraop stress response & improve HD stability)

Term

In positioning the patient for a laparoscopy, what should you be mindful of?

 

How much do you tilt pt?

Definition

careful padding and placement of braces

 

use only amount of tilt needed (~15-20 degrees) & adjust tilt slowly to avoid sudden HD & resp changes

Term

When should you verify ETT placement when doing anesthesia for a lap surgery?

 

Consider ____ placement of OGT to decompress stomach

 

*____ _____ prior to pelvic trocar placement

Definition

verify ETT placement following position changes & insufflation

consider early placement of OGT to decompress stomach

empty bladder prior to pelvic trocar placement

Term
What are the standard monitors?
Definition

EKG

BP

pulse ox

capnography

auscultation - esophageal or precordial

Term

What are the invasive monitors that can be used?

Are they routinely used?

Definition

 TEE likely more effective than CVP or PA due to increased intrathoracic pressure from pneumoperitoneum (this interferes w/ measurements)

 

no, rarely used

Term

What is the safest anesthesia technique?

 

Why?

Definition

general anesthesia with ETT

 

allows superior control of ventilation

Term
What agents should be used for surgery?
Definition

N2O - dont use at all with laps per Ron b/c of risk for N/V and increased size of any air emboli

propofol infusion

MR

antiemetics

Term
When should N2O be avoided?
Definition

avoid in intestinal surgery

controversy over NV

Term

Why is propofol beneficial?

 

When should it be avoided?

Definition

decreased NV

 

avoid with embryo transfer

Term
Are MR necessary?
Definition
not absolutely required, but may be helpful to surgeon
Term

Is a LMA a good option?

Why?

Definition

not really

less protection of airway

less control of ventilation

 

incr airway pressure d/t pneumoperitoneum & decr thoracopulmonary compliance

Term
What did the CDC report in regards to deaths with lap procedures?
Definition

1/3 of deaths related to laparoscopic procedures were related to anesthetic complications during GA without intubation 

 

 

 

SO PUT AN ETT IN

 

 

 

 

 

 

Term

Is a local & epidural ok for a lap procedure?

requires?

need to?

best with?

 

What does Ron think?

Definition

has been performed successfully

requires a skilled surgeon and willing patient

need to minimize IAP

maybe best with gasless lap

 

 

(according to Ron, this is not a good option)

Term
During laparoscopy a local in combination with sedation may result in _______ when combined with a pneumoperitoneum
Definition
hypoventilation = more CO2 buildup
Term

What may the sympathetic block with an epidural during larparoscopy leave _____ unopposed.

 

When may an epidural be helpful?

Definition

vagal reflexes = more brady risk

 

associated vasodilation may be helpful in select cardiac patients

Term

In the post-op care of lap patients, what 3 things may persist for a short while?

 

What else is common postop and can be prolonged for awhile?

Definition

increased SVR 

increased O2 demand

increased RR and EtCO2

 (above not usually a problem)

 

 NV

Term

What is the main cause of complications with laparoscopic gynecologic surgery?

 

When do most complications occur for this type of Sx and why?

Definition

intestinal injury

vascular

burns

 

most occur at the beginning w/ creation of pneumoperitoneum & involve trocar

Term

The main complications for general laparoscopic surgery (ie cholecystectomy) are?

 

When do the complications usually occur?

Definition

bowel perforation

CBD injury (common bile duct)

hemorrhage

 

occur later closely r/t surgical procedure, many involve hemorrhage

Term

What inert gases can be used as alternatives to CO2 pneumoperitoneum?

 

When using inert gases, are respiratory and HD effects decreased? Why?

Definition

 helium and argon

 

 No, respiratory and HD effects of pneumoperitoneum persist

 

bc IAP is increased

Term
What are the advantages of using inert gases? (2)
Definition

PaCO2 not elevated

smaller increase in BP

Term
What are the disadvantages of using inert gases?
Definition

greater decrease in CO

low blood solubility (safety issues r/t gas embolism)

Term

 advantages of using a gasless lap

 

r/t: resp and HD?

 

r/t: renal and splanchnic?

Definition

avoids respiratory and HD issues of pneumoperitoneum

 

no decrease in renal and splanchnic perfusion

Term

What are the advantages of using a gasless lap

 

r/t: port-site metastases?

 

r/t: pain & NV with a choley?

Definition

reduced incidence of port-site metastases w/ lap Sx for cancer

 

decreased pain & NV with choley

Term
What are the disadvantages of a gasless lap?
Definition
increased technical difficulty due to poorer exposure
Term

ROBOTICS


What is scaling?

Definition
surgeon moves 5cm, robot moves 1cm
Term

ROBOTICS

 

What is registration?

Definition
a mathematical process that allows location & anatomic orientation in 3-D based on data derived from CT or MRI
Term
What is a robot?
Definition

autonomous action based on registration

 

(programmed off-line & tasks are invoked on command; precise tasks such as drilling & probe insertion are based on registration; ex: robots used in ortho & neurosurg)

Term

What does an assist device do?

Is it autonomous?

Definition

controls instrument location and guidance

not autonomous, requires surgeon input

Term

What is a telemanipulator under control of?

How does it work?

Definition

under constant user control

mimics the operator's hand motions in exact or scaled motion

 

 (the system allows surgeon to be physically remote from pt, but surgeon can also be in OR)

Term

What are the advantages of robotic surgery? (6)

 

increased ______

filter of _____

less _____

______ hospital stay

better _____ result

potential for ____ ______ surgery

Definition

increased precision

filter of tremor

less pain

shorter hospital stay

better cosmetic result

potential for long distance surgery

Term
What is the DaVinci FDA approved for?
Definition

laparoscopy

thoracoscopy

mitral valve repair

Term
What is the Zeuss FDA approved for?
Definition

general surgery

laparoscopy

Term
What happened in 1987 and 1988 with robotics?
Definition

1987 - 1st lap choley done completely with telemanipulation

1988 - 1st totally endoscopic CABG

Term

What will some procedures with robotics require?

What's important to remember about the robots arms being engaged?

Definition

some procedures will require steep tilt of the patient

once the robot arms are engaged, the position can't be changed without removing them

Term
Is MR needed for robotic surgery?
Definition
yes, patient must remain paralyzed
Term

With thoracic procedures and robotics, what may be required for ventilation?

 

What is a standard monitor?

Definition

may require prolonged one lung ventilation

 

TEE pretty standard monitor

Term
What are general surgery procedures done with robotics?
Definition

choley

pyloroplasty

adrenalectomy

anti-reflux surgery

Term
What are cardiac surgeries amenable to robotic surgery?
Definition

internal mammary harvesting

CABG

mitral valve repair

ASD closure

ligation of PDA

Term
What are urology procedures done with robotics?
Definition

TURP

radical prostatectomy

vas deferens reanastomosis

Term
What are gynecology and orthopedic surgeries done with robotic?
Definition

gynecology - fallopian tube reanastomosis

orthopedics - total hip and knee

Term
What are the opthalmology surgeries done with robotics?
Definition

laser microsurgery

RAMS = robot assisted microsurgery system 

jointly developed with NASA

100:1 scaling

superior tremor filtering

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