Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
89 Cards in this Set
- Front
- Back
|
Minimally Invasive Surgery (MIS) |
-Is performed with the use of a lensed telescope and long instruments, which are introduced into the body through very small incisions at the operative site. - surgery is performed from outside the body by manipulating and working with long instruments utilizing the monitor view instead of direct visualization. |
|
|
Diagnostic and Operative Endoscope |
- Endoscope is performed with a flexible, semi rigid, or rigid endoscope, which is inserted into the body through a natural orifice such as the esophagus, colon or urethra. - The lens system channels for introducing small instruments and light systems are contained in one single tube which sometimes is referred to as an Insertion Tube. Ex: Bronchoscopies & Colonoscopies |
|
|
Robotic Surgery |
- Is a type of MIS in which the surgeon performs most of the procedure from a non-sterile Council located 10 to 20 ft from the patient. - Council controls communication with the instruments at the surgical site through a computer interface also Council displays the operative tissues in 3D and contains hand and foot controls that operate the instrument at the sterile field. |
|
|
Endoscope |
- Refers to a lensed tube with channels built into it for biopsy, irrigation, and suction-housed all together in one tube. - Is a interchangeable term with telescope. |
|
|
Telescope |
- Refers to rigid lens system inserts through an incision and used to visualize the anatomy and other instruments inserted through one or more additional incisions. - is an interchangeable term with endoscope. |
|
|
MIS vs. Open Surgery |
- Most important difference is how access to the surgical Anatomy is achieved. - Open surgery requires a larger incision. Performed directly on the tissue through that same incision. - MIS surgery the surgeon operates by viewing the image rather than viewing the anatomy directly. - surge Tech may be responsible for setting up the Imaging system and assisting in troubleshooting when there is a problem. |
|
|
Components of Imaging System |
Surgical Telescope/Endoscope Camera Head Camera Control Unit (CCU) Light Source LIght Cable Video Cables Monitor Screen Image Management System |
|
|
Light Source |
- transmits light to a fiber optic light cable. - control panel is used to adjust the modes and light intensity. - increase the GAIN if more light is required. - the *lighted-end of a cable can ignite drapes sponges and other materials especially in the presence of flammable or ignitable liquids such as alcohol. - light emanated from the telescope is cool as long as the light cable is attached to the telescope. - endoscopes require very intense white lights= xenon or LED lamps. |
|
|
Fiber Optic Light Cable |
- transmits light from the light source to the camera head or telescope. - easily broken by sharp impacts or over flexing of cable. - an adapter may be needed at the connecting Point because of different models and manufacturers (must be available and in place before surgery). - when transporting coil it loosely, never hang, but store in a flat position. - distorted image on the monitor = internal fractures. - attaches near the eyepiece |
|
|
Rigid Telescope |
- has a variety of optical angles. - always hope by its head (heavier) end never by the tip or shaft. - contact with heavier instruments/sharps can easily damage the delicate optical system and installation. - use only lint-free soft material to wipe telescope. - do not allow oils to come into contact with the lenses surface. - prevent lands fogging during surgery by warm water bath or use a defogging agent. |
|
|
* Optical Angle |
- this is the direction in which lenses are focused on the image measured and degree usually 0, 30, 45, and 70 degrees. |
|
|
Diameter |
- the diameter of the telescope shaft measured in millimeters. |
|
|
Length |
- the length of the telescope shaft measured in centimeters. |
|
|
Video Camera |
- receives visual data from the telescope and allows the surgeon to view structures without looking directly into the telescope. - modern surgical video cameras contains three solid-state silicon chips. |
|
|
Silicone Chips |
- produce electrical signals that are Amplified and displayed on the digital monitor. |
|
|
Three-Chip Cameras |
- produce natural color images which is important in the identification of pathology. - are located in the camera head or in some newer models they may be located at the tip of the telescope. - each silicon element in the chip represents one pixel. |
|
|
Pixels |
Determines the clarity of the image, depending on the number of units presented/contained. |
|
|
Video Format |
- the manner in which a video signal transmit information. - always check the compatibility with other components in the system when connecting them. - important aspect is the horizontal-to-vertical ratio of the pixels, which contributes to the clarity and resolution of objects transmitted to the monitor. (Ex: Standard/High Definition) |
|
|
Standard Definition |
- format has an aspect ratio of 4:3 which represents 640×480 pixels per vertical line. |
|
|
High Definition |
- format has a 16:9 aspect ratio, which is 7 times greater than SD modern systems use the HD format. |
|
|
Camera Head |
- the telescope mount connects to the telescope through a coupler, leveler or slide control. - the focus ring clarifies the image - camera head is delicate and must be handled with care. - Focus adjustment is made before surgery make sure the amount is locked during focusing. |
|
|
* Endocoupler |
- connects the camera to the telescope and is specific to the type of camera and scope and use. |
|
|
White-Balanced |
- a procedure to adjust the light color to the other components in the system. - done before each surgery. - two white balance a camera connect the light cable to the telescope and power of the light on high direct the lens of the telescope 3 to 5 inches away at a solid white object. - *avoid using porous/woven material (can cause shadows on an image). - recognized and registered automatically by the light source. |
|
|
Camera Control Unit (CCU) |
- is the receptacle for the camera. - contains the controls for light intensity, white-balance and resolution. - captures video signals from the camera head and processes them for display on the monitor. |
|
|
Video Cables |
- transmit digital data from the camera head to the CCU and from the monitor to the documentationSystem. |
|
|
Monitor |
- shows a projected image of the surgical site in real time the monitor most commonly used is the flat panel (liquid crystal display LCD). - monitors resolution must be matched to the cameras capability to produce the clearest view. |
|
|
Equipment Cart ("Tower") |
- provide sales for safe storage and transportation of video equipment. - allows equipment to be moved safely and efficiently. |
|
|
Intergated or Hybrid Operating Room |
- provides a method for the delivery and integration of digital technologies to the surgical suite. - components are built into overhead booms and controlled by remote control units or voice activation. - provides an interface for the control of equipment such as operating tables, temperature systems, and lighting. - system allows the video and voice components to be transmitted in real time to locations both in and out of the healthcare facility. |
|
|
Trocar-Cannula System |
- used to create ports for channels through the body wall for the insertion of MIS instruments. - commonly used during laparoscopic surgeries and thoracic MIS. - can be disposable, reusable, or reposable for a multiple but limited number of uses. |
|
|
Trocar |
- a solid rod with a blunt or sharp end that fits inside a hollow tube (cannula). - is advanced through the tissue. - when placed in the correct position the surgeon withdraws the obturator leaving the hollow cannula in place. - Sizes: Pediatrics to 8mm, Adults 5 to 10mm, Lg.&Special ( specimen retrieval) 10mm to 15mm, and microsurgical: 2mm and 3mm. |
|
|
Cannula |
- receives Mis instruments and is referred to or as a *Port. Sizes: Pediatrics to 8mm, Adults 5 to 10mm, Lg.&Special ( specimen retrieval) 10mm to 15mm, and microsurgical: 2mm and 3mm. |
|
|
Enhancing visualization during MIS |
1. Insufflation 2. Continuous Irrigation & Fluid Distention 3.Balloon Distention |
|
|
Insufflation |
- a process in which the abdominal and sometimes the thoracic cavities are filled with carbon dioxide gas (CO2). - provides a clear view of the anatomy and permit safe entry of the rigid telescope and other instruments during the procedure. |
|
|
CO2 |
- used because it is non-toxic, readily absorbed by the body, and nonflammable. - is warmed before insufflation (maintains the patient's core temperature and prevents lens from fogging). - is administered through a large-bore needle called a *Veress Needle or a trocar fitted for C02 insufflation to create a pneumoperitoneum.installation. - presents risk of pt. hypothermia because it rapidly cools as it fills space. |
|
|
Intraoperative pressure for laparoscopy |
12-15mm Hg |
|
|
Continuous Irrigation and Fluid Distention |
- is a technique used in arthroscopic MIS, hysteroscopy, and cystoscopy. - food is instilled into a body cavity or space to expand it and remove small tissue fragments and blood generated during surgery (can obscure the telescope view). - the choice of fluid used depends on the electrical surgical instruments used in the procedure. Older Systems= nonconductive solutions; glycine, sorbitol, ot mannitol. Newry System= isotonic saline irrigation. - the risk of electrical conduction and fluid balance depends on the solution. - *fluids are warmed before instillation. - presents risk of patient hypotherima. |
|
|
Intravasation |
- is the risk that fluids will be absorbed into the vascular system, causing increased blood pressure and electrolyte imbalance during surgery when a body cavity or organ is filled with fluid. |
|
|
Balloon Distention |
- is a soft plastic balloon with a tube and Port attached. - pushes the surrounding tissues aside without causing trauma and provides in anatomical space for the telescope and other instruments. - tissue specimens are retrieved from the body during MIS. |
|
|
Morcellation |
- the process by which large specimens and dense tissues are reduced to small pieces. - process reduces tissue to it pulp which can be suctioned from the wound. - large tissue specimens are retrieved through the abdominal wall through in retractable tissue bag inserted into a large cannula port. |
|
|
Hemostasis and Tissue Approximation |
- Clips are used in place of suture ligatures to occlude blood vessels or other types of hollow structures, such as the bile ducts. - stapling instruments are routinely used and open surgery (laparoscopic & VAT surgery). - various instruments have been designed to tie knots snug nuts and suture tissues within a confined space. - |
|
|
Three types of methods designed to tie not snug nuts and suture tissues within a confined space. |
- Extracorporeal Technique - Intracorporel Technique - Pre-Tied Surgical Loop |
|
|
Extracorporeal Suture Technique |
- the knot is tied outside the body cavity and then pushed into place with a not pusher. - technique; swaged suture needles combination our past and grasp through ports and cannula. - do not can be formed without tightening outside the body and introduced back into the body via the cannula. |
|
|
Intracorpreal Suture Technique |
- the suture is knotted and tightened inside the body with two grasping instruments inserted into two separate cannula ports. |
|
|
MIS Instruments |
- designed to perform a precise surgical task in a confined space. - instruments: reusable, disposable, and reposable. (Only the tips are disposable). - most commonly handle design is a transaxial type (2 finger rings @ a 90-degree angle to the axis of the instruments). - long shafts of the instruments are vulnerable to defects from normal wear. - loss of integrity to the instruments insulation creates a risk for patient burns. - electrosurgical instruments must be checked to make sure there are no breaks in the insulation (breaks may transmits stray current and cause an unintentional burns). |
|
|
Intraoperative Instrument Care |
- should be kept as clean as possible. - use damp sponge to wipe the tips and instrument shafts. - suction tips should be flushed frequently to prevent clogging. - use sterile water only (doesn't erode instruments). - place rigid telescope should be placed on a lint-free towel or in a warm water bath when not in use, for protection. - disconnect cablea and tubing when transferring the instruments from the operative field to the instrument table. |
|
|
Specialty Telescopes |
- are designed to fit the anatomical and technical needs of surgical specialties (abdominal, orthopedic, thoracic, and gynecological surgery). - features: length, diameter, channels for continuous Irrigation, and electrosurgical capability. Ex: Resectoscope |
|
|
Resectoscope |
- is a rigid telescope contained w/in a cutting and coagulation instrument, used in the sectional removal of tissue. - is fitted w/a cutting tip that uses laser or electrosurgical energy. - common use in genitourinary and gynecological surgery to remove tumors of the bladder, uterus, and to reset the prostate. |
|
|
Direct Coupling |
- the active electrode comes in contact w/another conductive instrument, causing burns. |
|
|
Unintentional Direct Coupling |
- electrosurgical energy can be transmitted from the tip of the active electrode to nearby instruments when they are accidentally touched or are close to each other, causing accidental burns. |
|
|
Capacitance Coupling |
- occurs when stray electrical current is transmitted from an electrosurgical instrument or other conductive material to tissue, even though no break in the insulation may be apparent. - causes: the active electrode is threaded through metal cannula. the active electrode is an integral part of the operating laparoscope. the active electrode is threaded through a metal suction-irrigation tube. |
|
|
Capacitor |
- a point in an electrical circuit where energy is built up or stored btwn insulators. - w/ metal cannula the energy is dispersed over a wide area and may not cause a problem. - plastic cannula anchors can insulate the cannula from the body wall, electricity passes down the cannula and can cause a burn on contact w/deep body tissue. |
|
|
Active Electrode Monitoring (AEM) |
- is the most effective means of preventing burns. - a system in which the instruments are self-monitoring during use. - all metal cannula are the safest types. - do not place electrical cords and fiber-optic cables across traffic areas in the operating room. |
|
|
Ultrasonic Energy |
- coagulation tissue by creating a cool coagulation at the cellular level. - no electrical energy and very little heat are involved. - systems: sonosurg and harmonic scalpel. |
|
|
High-Frequency Biopolar Electrosurgery |
- is used to coagulation and cut through tissue. - most common, a hook probe is used to simultaneously cut and coagulation tissue. Scissors and grasping instruments also available. |
|
|
*Precautions used to reduce the risk of fire during laser surgery? |
Sponges and towels are moistened in normal saline or water. The patient's eyes are protected with corneal shields. A noninflammable endotracheal tube is used. |
|
|
MIS Patient Positioning |
- depends on the surgical site and the pt.'s physiological condition. - is identical to open surgery. - abdominal and pelvic procedures require the pt. to be positioned in lithotomy w/trendelenburg or reverse trendelenburg. |
|
|
Upper Abdomen/Lower Esophagus |
- pt. is placed in reverse trendelenburg position. - padded footboard is used to prevent the pt. from sliding downward. |
|
|
Pelvic/Abdominal Laparoscopy |
- pt. placed in trendelenburg position. - bean bag vacuum positioner or anti-skid device must be used to hold the pt. in position and prevent him or her from sliding. - gynecological pt./those undergoing prostate are placed in the lithotomy position. |
|
|
VATS |
- lung & bronchi procedures pt. in lateral decubitus position. |
|
|
Arthroscopyn of the shoulder or knee |
- pt. in beach-chair position w/arm free. - knee= pt. in the supine position w/operative leg free. |
|
|
MIS Skin Prep&Draping |
- is performed as if for open case, which allows for possibility of conversion to an open case. |
|
|
Flexible Endoscope |
- methods of viewing the inside of the body passage and hollow organs such as the gastrointestinal system, urinary bladder, uterus, nasal sinuses bronchial tree and larynx. - it's introduced through a natural opening in the body such as the mouth of nose. - surgeon can remove tissue for biopsy or take cell brushes through the flexible endoscope. - 2 main sections: head & insertion tube. - do not use video technology also have an eyepiece on the control head. - some have a auxiliary water Channel which is used to clear Blood and Tissue debris from the lenses. - air channel is used to insufflate the aluminum of the gastrointestinal tract to create space in the same way as in a pneumoperitoneum. |
|
|
Instrument Channel a.k.a Elevator Channel |
- receives biopsy forceps, brushes, and other instruments used to remove tissue specimens. (flexible endoscope) |
|
|
Capsule Endoscope |
- used to perform the endoscopic procedures of the small intestines, esophagus, and large intestines. - device is the size of a large vitamin and contains a high resolution camera lenses light emitting diode and batteries. - is swallowed by the patient or placed using routine endoscopic techniques. |
|
|
Robotic Surgery |
- first system appeared in the mid 1980s. - developed by a collaborative group; NASA, DOD, SRI. - 1994 the first cleared FDA device appeared by 1998 it was used in the first human patient. - surgical technologists have a significant role in robotic assistance surgery learning starts with the Knowledge and Skills in MIS surgeries. |
|
|
Robotic Assistant Surgery |
- sub type of computer-assistance surgical system (CAS). - uses computer technology and software to control and manipulate surgical instruments. |
|
|
Scaled Movement |
- the computer interface can translate movement to a much smaller scale (1:2 to 1:5), enabling greater position without demanding greater motor skills. - also dampers or remove normal hand tremor. |
|
|
Image Registration |
- is the layering of multiple images of the same subject to produce a blended image in three dimensions. |
|
|
Autonomy |
- robots used in industry are programmed to perform repetitive tasks once the system has been programmed it can perform those tasks autonomously within the digital parameters established. - robotic assistant surgical systems are Not autonomous. (their actions are under the direct control of the surgeon). |
|
|
Surgeon Console |
- non-sterile control station where the surgeon sits or stands while operating. - here the surgeon can manipulate the surgical instruments, adjust the parameters of the optic system, and perform many other tasks. |
|
|
Remote Data Display |
- pt.'s CT or MRI scans can be displayed on the screen monitor at any time as remote data display. |
|
|
Image Guided Navigation |
- is used in some systems especially those develop for orthopedic surgery and neurosurgery. - systems using this feature are able to overlay the CT image onto the real time display for precision tissue modeling. |
|
|
Bedside Unit |
- is the receptacle for the surgical instruments and endoscope which are inserted into designated arms. - The DaVinci system that features multiple arms and instruments on the same base refer to the bedside unit as a "patient cart"Cart. - the circulating nurse is responsible for its management and positioning during surgery. - operation of the cart is prescriptive (ordered by the surgeon), meaning only license staff may operate the cart during patient care. |
|
|
End Effector |
- the working tip of a RAS or a MIS instrument. |
|
|
Degrees of freedom |
- MIS = 4 degrees plus opening and closing the jaws. - RAS = 7 degrees plus opening and closing. - this enables very fine movement in all directions. |
|
|
Wristed |
- has been coined to describe instruments whose tips are multi-directional. |
|
|
Pivot |
- the degree of rotation. |
|
|
Roll |
- an airplane that dips its wings in either. |
|
|
Pitch |
- the nose-up and nose-down positions. |
|
|
Yaw |
- right and left turns in space. |
|
|
Reprocessing Robotic Instruments |
- reposable instruments can only be reprocessed a designated number of times. - disposed of in the same category as sharps. |
|
|
Haptic Feedback |
- refers to the sense of touch. - transmitted to the surgeon's hand either directly by palpation or through the surgical instruments. - da Vinci do Not feature haptic feedback, so surgeon maut rely on visual cues. |
|
|
Near-Infrared Imaging |
- is used during surgery to illuminate anatomical structures. - flurescing substance (indocyanine dye) is injected intravenously. - used to assess local perfusion, such as an anastomosis site that the surgeon has just created. |
|
|
Surgical Access |
Refers to the method used to enter the body to perform a surgical procedure. - ex: incision, trocar-cannula (port) system. |
|
|
Initial Access |
- is the first step in robotic procedure in which a body space is entered. - noted on the surgeon's preference card. |
|
|
Penumoperitoneum |
- is required to enlarge the potential space in the abdomen or thorax to enable MIS and robotic procedures. - the abdominal cavity is normally under negative pressure. |
|
|
Hasson |
- is a trocar that is suture in place. - is an open procedure. |
|
|
Hemorrhage |
- is the most common cause of conversion to an open case. |
|
|
Tamponade |
- maybe caused from the working space and small instruments used in MIS. - finding the source of bleeding is more difficult because immediate exposure of the tissues is limited. |
