Chapter 21: Endoscopic

Front 1

Minimally Invasive Surgery (MIS) is performed using a ___ lensed telescope and long instruments

Back 1

Ridged

Front 2

The telescope and long instruments are inserted into ____ incisions at the operative site.

Back 2

small

Front 3

In the MIS technique, the operative space may be enlarged with fluid or ____ ____.

Back 3

carbon dioxide

Front 4

The goal of the minimally invasive technique is primarily surgical rather than ____.

Back 4

diagnostic

Front 5

____ endoscopy and operative endoscopy usually are performed with a flexible, semirigid, or rigid endoscope that is inserted into an anatomical opening in the body.

Back 5

Diagnostic endoscopy

Front 6

The ____ system, channels for introducing small instruments, and light system are contained in one long tube.

Back 6

lens

Front 7

Flexible endoscopy is used to assess the regional anatomy, to obtain tissue biopsies, and to perform ____ surgical procedures.

Back 7

minor

Front 8

The ___ endoscope is used to perform a surgical assessment and operative procedures, such as transurethral resection of the prostate and transcervical resection of a uterine fibroid tumor.

Back 8

rigid endoscope

Front 9

____ instruments refers to the rigid lensed instruments used in MIS.

Back 9

Telescopic instruments

Front 10

____ is used to describe the flexible lensed instrument that is passed through a natural orifice for assessment or surgery of a hollow organ, duct, or vessel.

Back 10

Endoscope

Front 11

Narrow tubes called ____ are inserted into each incision.

Back 11

Cannulas

Front 12

How long do the cannulas remain in place?

Back 12

throughout the entire surgery

Front 13

The cannulas ____ the body wall and also maintain a seal between the inside of the body and the outside environment.

Back 13

protect

Front 14

To perform surgery inside the body, the surgeon inserts a slender optical ___ through one of the cannulas.

Back 14

telescope

Front 15

Surgery is performed by adjusting the ____ to obtain different views and by manipulating the telescopic instruments as the appear on the monitor

Back 15

endoscope

Front 16

Advantages to MIS:
-Reduced Tissue Trauma
-Less blood loss
-Less pain
-Faster recovery and return to normal activities
-Can be done as out patient surgery in many cases
-Reduced postoperative pain
-Increased patient satisfaction
-Less costly

Back 16

NOTE ---->>>>

Front 17

Patients who have undergone previous abdominal procedures have a high risk of abdominal ___.

Back 17

adhesions (scaring of organs that causes adherence to the peritoneal wall)

Front 18

Endoscopic instruments are limited in their ___ of ___.

Back 18

range of motion

Front 19

In an MIS procedure the operating space is very small, which reduces maneuverability and may ___ the duration of the procedure.

Back 19

lengthen

Front 20

Not all patients are suitable for MIS. Some patients cannot tolerate the effects of ____

Back 20

insufflation (inflation of the abdominal cavity)

Front 21

All surgical risks depend on the condition of the ____ at the time of the surgery.

Back 21

patient

Front 22

Very sick patients are at greater risk of ____ problems, including those associated with positioning, abdominal insufflation, and the use of fluids to expand body cavities.

Back 22

physiological

Front 23

In laparoscopy the abdomen is filled with ____ ____

Back 23

carbon dioxide

Front 24

In arthroscopy (MIS of the joint spaces), the anatomical space is filled with ____ ____

Back 24

irrigation fluid

Front 25

Hollow organs, such as the bladder, are filled with ____ or other isotonic fluids during endoscopy.

Back 25

saline

Front 26

In some anatomical regions, such as the inguinal area, a ___ dissector is used to separate dense tissue planes without causing trauma.

Back 26

balloon

Front 27

In general, patient positioning for mIS is identical to that for ____

Back 27

open surgery

Front 28

For what kind of surgery is the patient tipped into reverse Trendelenburg position to displace abdominal viscera. (padded footboard, substantial padding is required to prevent nerve and vascular damage)

Back 28

Upper abdomen or lower esophagus

Front 29

During upper abdomen or lower esophagus MSI surgery the scrub must adjust the ___ or other overhead tables

Back 29

Mayo stand

Front 30

During upper abdomen or lower esophagus MIS surgery, if the table must be moved the circulator must ensure that the new position does not create ____ ____ between the patient and OR table.

Back 30

pressure points

Front 31

For ____ or lower abdominal procedures the patient is placed in the Trendelenburg position.

Back 31

Pelvic or lower abdominal procedures

Front 32

The Trendelenburg postion can compromise patient's lung capacity and cause hypotension from increased pressure on the ____ ____

Back 32

vena cava

Front 33

A gynecological patient is placed in the ____ position, which exposes the patient to risks associated with popliteal nerve and vessel injury.

Back 33

lithotomy

Front 34

Thoracoscopy or nephroscopy procedure of the lungs, bronchi, and upper urinary tract are performed with the patient in ____ position

Back 34

lateral

Front 35

Laryngoscopy, bronchoscopy, esophagoscopy, and mediastinoscopy procedures of the upper airway, upper gastrointestinal tract, and mediastinum are performed with the patient in ___ position

Back 35

supine

Front 36

A ____ patient undergoing bronchoscopy may be placed in the Fowler position.

Back 36

conscious

Front 37

To prep and drape the patient for an MIS is the same for an open procedure. This is particularly true for lap, retroperitonal, and thoracoscopic surgery bc they are more likely converted into other types of surgery

Back 37

NOTE ---->>>>

Front 38

If more light is required, the ____ is increased rather than light intensity.

Back 38

gain (the signal intensity)

Front 39

High-resolution video endoscopy requires very intense ___ light.

Back 39

white

Front 40

For the high-resolution video endoscopy ____ lamps are preferred

Back 40

Xenon

Front 41

The light emitted from the telescope is ___ as long as the light cable is attached to the telescope.

Back 41

cool

Front 42

Light rays emitted from the end of the cable when it is detached from the telescope are ____ hot.

Back 42

extremely

Front 43

The lightened end of the cable can ignite drapes, sponges, and other materials, especially in the presence of flammable or ignitable liquids such as ____.

Back 43

alcohol

Front 44

Always turn the light source to its ____ or standby mode before disconnecting it from the telescope or light cable

Back 44

lowest

Front 45

When storing or transporting a fiberoptic cable coil it ____.

Back 45

loosely

Front 46

Do not ___ a fiberoptic cable; instead store it in a flat position.

Back 46

hang

Front 47

Do not allow a fiber optic cable to strike a hard surface. This can cause the fiberoptic bundles to fracture. Internal fractures are not visible from the outside.

Back 47

NOTE ---->>>>

Front 48

Power ___ the light source before connecting or disconnecting a fiberoptic cable

Back 48

off

Front 49

Do not hande light source bulbs with bare hands. ___ ___ can reduce the life span of the bulb.

Back 49

skin oils

Front 50

Xenon light sources have bulbs that have a finite life, and ____ must be available during surgery.

Back 50

replacements

Front 51

All cameras must be ___-___ before each procedure.

Back 51

white-balanced

Front 52

White-balance is a procedure to adjust the ___ color to the other components in the system.

Back 52

light

Front 53

To white-balance the camera: connect it, turn it on high, and direct it to something white such as white paper and it will adjust automatically

Back 53

NOTE ---->>>>

Front 54

To white-balance the camera do not use porous or ___ material such as surgical sponge bc it can cause shadows on the image

Back 54

woven

Front 55

The optical angle are usually measured in degrees of 0, 30, and __.

Back 55

45

Front 56

The diameter of the telescope shaft is measured in ____

Back 56

millimeters (mm)

Front 57

The length of the telescope shaft, measured in ____.

Back 57

millimeters (mm)

Front 58

Power ___ the light source before connecting or disconnecting a fiberoptic cable

Back 58

off

Front 59

Do not hande light source bulbs with bare hands. ___ ___ can reduce the life span of the bulb.

Back 59

skin oils

Front 60

Xenon light sources have bulbs that have a finite life, and ____ must be available during surgery.

Back 60

replacements

Front 61

All cameras must be ___-___ before each procedure.

Back 61

white-balanced

Front 62

White-balance is a procedure to adjust the ___ color to the other components in the system.

Back 62

light

Front 63

To white-balance the camera: connect it, turn it on high, and direct it to something white such as white paper and it will adjust automatically

Back 63

NOTE ---->>>>

Front 64

To white-balance the camera do not use porous or ___ material such as surgical sponge bc it can cause shadows on the image

Back 64

woven

Front 65

The optical angle are usually measured in degrees of 0, 30, and __.

Back 65

45

Front 66

The diameter of the telescope shaft is measured in ____

Back 66

millimeters (mm)

Front 67

The length of the telescope shaft, measured in ____.

Back 67

millimeters (mm)

Front 68

Power ___ the light source before connecting or disconnecting a fiberoptic cable

Back 68

off

Front 69

Do not hande light source bulbs with bare hands. ___ ___ can reduce the life span of the bulb.

Back 69

skin oils

Front 70

Xenon light sources have bulbs that have a finite life, and ____ must be available during surgery.

Back 70

replacements

Front 71

All cameras must be ___-___ before each procedure.

Back 71

white-balanced

Front 72

White-balance is a procedure to adjust the ___ color to the other components in the system.

Back 72

light

Front 73

To white-balance the camera: connect it, turn it on high, and direct it to something white such as white paper and it will adjust automatically

Back 73

NOTE ---->>>>

Front 74

To white-balance the camera do not use porous or ___ material such as surgical sponge bc it can cause shadows on the image

Back 74

woven

Front 75

The optical angle are usually measured in degrees of 0, 30, and __.

Back 75

45

Front 76

The diameter of the telescope shaft is measured in ____

Back 76

millimeters (mm)

Front 77

The length of the telescope shaft, measured in ____.

Back 77

millimeters (mm)

Front 78

Telescopes are delicate and expensive the ST is responsible for ___ and maintaining the telescope in a manner that prevents errors.

Back 78

handling

Front 79

The circuit used in video endoscopy is called a ___-coupled device. (CCD)

Back 79

charge-coupled device

Front 80

The HD is __ times greater than the SD.

Back 80

7 times

Front 81

The endocoupler connects the ____ and telescope and is specific to the type of camera and scope in use.

Back 81

camera

Front 82

When transporting a camera hold it ____.

Back 82

firmly

Front 83

When connecting and disconnecting the camera head, make sure the lock ring is ____. Also make sure the camera is attached to the lock ring after engaging.

Back 83

disengaged

Front 84

After connecting the camera head to the telescope and camera is control unit, make sure the light is clearly emitted and is not ____.

Back 84

flickering

Front 85

The CCU should be able to convert SD to ___ signals or vice versa so that images from one format can be viewed by another.

Back 85

HD
CCU= Camera Control Unit

Front 86

A resectoscope is a ridged telescope contained within a cutting and ____ instrument; it is used in the sectional removal of tissue.

Back 86

coagulating

Front 87

The ____ commonly is used in GI and gynecological surgery to remove tumors of the bladder and uterus and to resect the prostate.

Back 87

resectoscope

Front 88

The resectoscope is fitted with a ____ tip that uses laser or electrosurgical energy to remove tissue

Back 88

cutting

Front 89

Common specialty rigid telescopes: Laparoscope: ___ and pelvic surgery

Back 89

abdominal

Front 90

Common specialty rigid telescopes: ____ : joint surgery

Back 90

Arthroscope

Front 91

Common specialty rigid telescopes: Hysteroscope: Surgery of the ____

Back 91

uterus

Front 92

Common specialty rigid telescopes: ____: thoracic surgery

Back 92

Thoracoscope

Front 93

Common specialty rigid telescopes: ____: kidney surgery

Back 93

Nephroscope

Front 94

Common specialty rigid telescopes:Cystourethroscope: surgery of the ____ and associated structures

Back 94

Bladder

Front 95

Endoscopic instruments are designed to perform a precise surgical task in a ___ space.

Back 95

confined

Front 96

A rotational design, such as that used in ___ surgery, allows the tip of the instrument to swivel in a n arc, increasing maneuverability of the instruments.

Back 96

robotic

Front 97

The most common handle design is a transaxial type, which has two finger rings at a ___-degree angle to the long axis of the instrument.

Back 97

90-degree

Front 98

Endoscopic scissors are available in straight, ____, and hooked configurations.

Back 98

curved

Front 99

The trocar and cannula are assembled by the ST before ____

Back 99

insertion into the patient

Front 100

Cannulas are available in the following ranges:
Pediatric: __-__ mm
Adult 5-10 mm
Large and special purpose (specimen retrieval) 10-15 mm

Back 100

5-8 mm

Front 101

Abdominal surgery usually requires at least ____ trocars.

Back 101

three

Front 102

During abdominal surgery the video telescope usually is placed near the ____, approx 10 in (25 cm) above the pubic symphysis. Others are placed right or left of the midline.

Back 102

midline

Front 103

When CO2 is used during insufflation is ___ before it is used.

Back 103

warmed

Front 104

The insufflation unit is the ____ console for delivering the correct amount, temp, and pressure of CO2.

Back 104

control

Front 105

To create a pneumoperitoneum, the surgeon inflates the abdoment with CO2 through a large-bore needle called a ____ needle.

Back 105

Veress

Front 106

When a body cavity or organ is filled with ____ during surgery, the risk exists that it will be absorbed into the vascular system; this is called intravasation.

Back 106

fluid

Front 107

A ___ test is often done to verify the position of the Veress needle in the abdominal cavity.

Back 107

saline

Front 108

The pressure of the saline is usually maintained at __ to __ mm Hg.

Back 108

12-18 mm Hg

Front 109

(In the process of insufflation)
Before it is attached, the tubing is flushed with ____ to purge any air from the tube and prevent air embolism

Back 109

CO2 gas

Front 110

When the pressure of the irrigation exceeds a safe level, causing fluid to enter the vascular system and thereby increasing ____ ____.

Back 110

blood pressure

Front 111

The circulating nurse and the ___ monitor fluid pressure during fluid distention procedures.

Back 111

surgeon

Front 112

The circulating nurse and scrubbed surgical tech share responsibility for keeping track of the amount of ___ used and the amount of runoff during the procedure.

Back 112

fluid

Front 113

The balloon dissector is used in reconstructive plastic surgery and in ____ and abdominal wall procedures.

Back 113

vascular

Front 114

All MIS instruments are insulated with materials that do not ____ ___.

Back 114

conduct electricity

Front 115

A capacitor is a point in an electrical circuit where energy is built up or ____ between insulators.

Back 115

stored

Front 116

The most effective means of preventing burns is ____ ____ ____ (AEM), a system in which the instruments are self-monitoring during use.

Back 116

active electrode monitoring

Front 117

Ultrasonic technology is used during MIS for _____ and cutting.

Back 117

coagulation

Front 118

Ultrasonic energy coagulates tissue by creating a ___ coagulum at the cellular level.

Back 118

cool

Front 119

Ultrasonic energy uses no ___ energy and very little heat are involved.

Back 119

electrical

Front 120

Bipolar energy can be an effective method of hemostasis when the combination of low ___ and high ____ is used.

Back 120

low power and high frequency

Front 121

In the extracorporeal suture technique, the knot is tied ____ the the body cavity and then pushed into place with a knot pusher.

Back 121

outside

Front 122

In the intracorporeal technique, the suture is knotted and tightened ____ the body with two grasping instrument inserted into two separate cannula ports.

Back 122

inside

Front 123

Ligation loop is...

Back 123

a loop of suture contained in a carrier, similar to a snare is delivered through the laparoscopic and looped around the tissue, tightened, and ends are cut.

Front 124

Telescopes should be maintained on a ___ or other soft surface to prevent them from rolling off the table.

Back 124

towel

Front 125

____ clamps must be used to secure cords and tubing to drapes. (fiberoptic and camera cables)

Back 125

Nonpenetrating clamps

Front 126

Always allow sufficient ___ on cord attachments and be alert to changes in table position, which can cause cords to be dragged.

Back 126

slack

Front 127

Give some examples of some MIS procedures that could turn into an open case

Back 127

laparoscopy, pelvic, and thoracic surgery

Front 128

The flexible endoscope is most often used for examination, visual exploration, and ____.

Back 128

biopsy

Front 129

The flexible endoscope has two main sections, the head and the ____ tube.

Back 129

insertion

Front 130

The water channel on the endoscope is used to clear ____ and tissue debris from the lens.

Back 130

blood

Front 131

The ____ channel is used to manipulate instruments and remove tissue specimens.

Back 131

elevator channel

Front 132

Flexible endoscopy usually is performed in an ____ setting

Back 132

outpatient