Chp 6 Biomedical Science and Minimally Invasive Surgery

Hardware

An overall term used to describe the components of any computing device that can be touched, manipulated, and handled.

(CPU) Central Processing Unit

Location: Silicon chip located within a case

Functions:

* Coordinates operations of computer

*Manages computer systems

*Facilitates exchange of date with computer memory

Modem

Location: Internal or External device

Function(s): Facilitates sending information over telephone line (e.g, Internet searches and email)

Monitor

Functions:

*Screen displays output of computer

*Viewable space is measured diagonally

*Resolution refers to clarity of the screen image

What is the start up process for turning on a computer & hardware sometimes referred as

Booting

Word Processing

Creating a document file.

What is the best-known programs available for creating presentation

PowerPoint & Prezi

(PowerPoint is part of Microsoft Office tools)

What does (WWW) stands for

World Wide Web

The search bar/browser usually start with

http://

https://

.com

usually corporations

.org

are nonprofit organizations

.gov

government agencies

.edu

educational Institutions

The phrase surfing the Internet refers to

Looking at many different sites and web pages and switching from one to another.

(This is similar to browsing through a magazine; therefore, software for accessing the web is often referred to as a browser)

Using what ____________ makes Surfing or browsing possible

Hyperlinks-the bold or underlined words on a particular web page

When pointing the MOUSE to a hyperlink, what happens

The arrow changes to a HAND with the index finger pointing to the item.

Browsing is also performed by using a search engine such as

Ask®, Bing®, Google®, or Yahoo®.

Favorite Feature:

Allow the user to save addresses permanently for easy access

Bookmark Feature:

Is used to save a web address in Favorite Feature

History Feature:

Displays sites that have been accessed previously

Importing Photographs and drawings can be imported into a document from the Internet. Be aware, however, that material placed on the Internet—in particular, documents and photographs is often

Copyrighted (Unless a website specifically states that copying is permitted)

Laparoscopic Cholecystectomy pertain to

Removal of Gallbladder

When performing a Internet Search

Keep the subject to one word or a short and succinct phrase. As a rule of thumb, the first 20 to 30 articles listed pertain directly to the subject area.Use quotation marks around the phrase to tell the search engine to search only for those exact words.

Intellectual Property

Is the concept of legal protection for an individual against others using his or her work (article, book, music, product, concept, etc.) and claiming it as their own.

Plagiarism

Individuals using materials found on the Internet without crediting the author by placing quotation marks around the original text and citing the source could be accused and found guilty of plagiarism.

Personal emails as well as search engine histories may be monitored by

the facility or corporate information technology (IT) department. Users should be prudent in their use of employer-controlled networks and use them only for legitimate work-related communications.

What does Computers in the Healthcare facilities add

A new dimension to Surgical Patient Care

Electronic Medical Records ( EMRs)

Care of patients in the perioperative setting is increasingly being coordinated through use of electronic medical records or EMRs due to mandates by the Centers for Medicare and Medicaid Services (CMS).

Surgical procedure and the condition of the patient throughout the preoperative and intraoperative periods. Charges for inventory and billing purposes are included on the

EMRs (Electronic Medical Records) Process

What should not be given to the surgeon over an intercom or speakerphone in cases where the patient has received local anesthesia and is awake.

Biopsy Results

**(but the information can be sent via computer to the surgery department or directly into the OR for the surgeon to read)**

Scheduling Surgical Procedures

Has been streamlined because of computer technology. The information saved in the computer is easily updated and can be printed or sent by email prior to surgery in order to disseminate the information to surgical personnel and to other pertinent hospital departments. The surgery schedule can be scanned, saved, and sent as an email attachment.

Surgeons' Preference Cards

1. Were handwritten with notes scribbled in the margins, often becoming illegible.

2. If the surgeon had privileges at more than one hospital, it was difficult to get copies of the cards or, if the surgeon moved, the cards would be left behind.

3. The majority of surgical facilities develop and save preference cards electronically, making it easier to update the cards and obtain an accurate copy when preparing for a surgical procedure.

Instruments Count Sheet

just as with the surgeon's preference cards, the instrument list/count sheet for the assembly of instrument trays can be entered, saved, updated, and printed.

Sterile Processing Documentation

Computers have substantially reduced the paperwork of the sterile processing department. Supplies can be ordered online, inventory records maintained electronically, and records related to the sterilization of supplies and equipment saved on the computer.

Annual Staff Competency Training

Many hospitals require annual online competency test completion for employees

Hospital and departmental Policy and Procedures (P&Ps) manuals in many institutions have been replaced with

Online Resources accessible to employees from any computer after signing on to the hospital INTRANET. Continuing education (CE) credits may also be tracked more easily

What instruments doesn't need a grounding pad

Biopolar

Number of ways that a robot manipulator can move

(manipulator- robots arms)

Degrees of Freedom

Where would you ground on a patient for a Laparoscopic (Gallbladder)

Interior Thigh

Where should the ESU (Bovie) be placed when not in use

Holster, to prevent inadvertent activation and ignition of and tip possibly injuring patient.

Harvard physicist, William T. Bovie, PhD, and Harvey Cushing, MD, a neurosurgeon considered the father of modern neurosurgery, developed the first electrosurgical generator.

In 1926

The______________ is the only procedures that allow you to ground on the backside, but for laparoscopic its the interior thigh

Heart

Although the electrosurgical unit (ESU) is completely different from the original machine developed by Bovie, many still refer to the ESU as

Bovie

Basic Principles of Electricity

The principles that govern the behavior of tiny particles known as electrons are called the electron theory,

Matter

Is anything that has mass and occupies space

The center of the atom is called the__________ and contains protons, positively charged electric particles, and neutrons, neutral particles.

nucleus

Electricity Describes what?

The free electrons moving or flowing from the ring of one atom to another

- Bohr's Theory

Electric current

Movement of the electric charge

Mayfield Brace

The _________________ frame is use for patient in the prone position

Wilson Frame

Only ________________ goes in the kick bucket, not trash

Sponges

Insulators

Materials that stop the flow of electrons

- Rubber & Plastic is most common

- HIGH humidity results in static charge leakage

- LOW humidity results in formation of sparks

- humidity in the OR should be maintained between 20 percent and 60 percent.

Conductors

Material that allow the flow of free electrons

- Copper is the most common conductor

- Water is a conductor of electricity

What should you NOT do, if the patient wasn't grounded

Connect/Turn On the Bovie

Circuit

Path that electricity travels- From the energy source to a device and then back to the energy source

Volt

Electrical Potential

Current

- Measured in Amperes (AMPS)

- Flow of electric charge or the rate of flow of electrons

Load

Device that uses the electricity to perform some type of function

Ex: Electrocaudary, Surgical Lamps, Cell Saver

Voltage

Potential energy of electrons at any given time between 2 points

Once Surgeon made first skin cut

1. Do not take blade from him

2.Place blade on back table, and replace with new blade

3.1st blade for skin cut, and when going deep, new blade for deep cut, because skin blade been on the skin

When expose to chemicals (formalin) or Hurt yourself, you should seek the

MSDS

Plugs used in surgery have three prongs. Components of the three-prong plug are:

1st prong - Positive

2nd prong - Negative

3rd prong - Ground

Wall Outlets

are usually 110 volts (V), excluding the outlet for the mobile X-ray unit and some laser units, which require 220 V

Electrical current ultimately seeks to go to the earth or

Ground

Alternating Current (AC)

Describes the flow of current that reverses direction periodically

- A complete AC cycle occurs when current moves in one direction and then reverses its course = 1 Hertz (Hz)

Frequency

Number of waves per cycle per second

•Direct current and alternating current:

-Direct current (DC): electrical current that flows in one direction from the negative pole to the positive pole.

-Alternating current (AC): flow of current that reverses direction periodically.

The four components of a DC circuit are:

Source of electricity (e.g., battery)

Conductor (e.g., wire from source to load)

Control device (e.g., switch)

Load (e.g., bulb, heater, or other load)

Radio Frequency

Is that the number of wave cycles (one cycle is called a hertz) per second is called frequency.

(IPS) Isolated Power Systems in the OR

-Are frequently used to monitor power overloads and prevent potential fires caused by faulty equipment or excess electrical current usage.

-If the light turns red and/or an audible alarm sounds, the last piece of electrical equipment plugged into the wall outlet should be carefully unplugged. The device may have an electrical short in its circuit or may have overloaded the electrical system in that room.

-If the IPS light returns to green and the alarm ceases, the equipment generator should be removed from service and checked by the biomedical engineer before returning it to use.

•Electrosurgery:

-Application of electrical current through tissue to coagulate or cut tissue.

Components of Electrosurgery

1. Generator

2. Foot pedal

3. Cords

4. Active electrode

5. Dispersive Electrode (grounding pad)

Monopolar Electrosurgical Unit

- Used for coagulation mostly, sometimes cutting

3 main components:

1. Generator

2. Active Electrode

3. Dispersive Electrode (Grounding pad)

From generator -> to pencil tip -> to cut/coagulate the tissue -> to the grounding pad -> to the generator

Emits sound that should NEVER be turned off

Bipolar Electrosurgical Unit

From generator -> tip of the active electrode -> to tissue -> to other tip of active electrode -> to generator

- Used for coagulating only

The ESU uses two modes to deliver the electrical current to the tissue:

monopolar and bipolar

The _____________ is capable of changing the frequency levels, creating a blending of the coagulation and cutting functions to achieve a combined result.

ESU Generator

Monopolar electrosurgery is used when relatively_____________ are involved.

Large surgical areas

The _________ mode is used less frequently and is only used for the purposes of coagulation, not cutting.

Bipolar

_____________ is used for delicate surgical procedures, at sites where moisture is nearby, to prevent damage to delicate tissue and nerves, or in certain patients with implanted pacemakers or other devices that might be affected by the ESU monopolar current.

Bipolar Electrosurgery

______________ activates the generator with a hand control located on the active electrode or with a foot pedal when laparoscopic instruments without activation triggers are used. The main power or electrical cord is attached to the back of the ESU

The surgeon

Some generators are capable of operating in both________________ mode

monopolar and bipolar

Why Bipolar doesn't require a grounding pad

The active and return electrodes consist of the two prongs or tines of a forceps, eliminating the need for a grounding pad. The forceps and cord may be reusable.

The surgical technologist sets up the forceps and cord in the same method as the ESU pencil by preparing it for use at the back table and, following draping, securing it to the sterile drape at the sterile field. The end of the cord is passed off to the circulator for attachment to the generator and the circulator adjusts the power settings.

The surgeon will activate the bipolar forceps with the use of a foot pedal.

The bipolar current is as follows:

1. Current flows from generator to the active electrode (one of the prongs of the forceps).

2. The active electrode delivers the coagulating current to the surgical site tissues or vessels.

3. Electrical current passes through the tissue between the tips of the forceps prongs.

4. Current returns to the generator via the return electrode/prong and to the cord.

The pathway of the monopolar ESU current is as follows

1. Current travels from the generator to the active electrode (ESU pencil or laparoscopic instrument with ESU cord attached).

2. The active electrode is activated by the surgeon to deliver the cutting or coagulating current to the tissue or vessel.

3. The electrical current then passes through the patient's body to the grounding pad.

4. The current exits the patient's body via the grounding pad and returns to the generator.

Advantages of Elecrtosurgery

-Reduces blood loss

-Saves time

-Cutting current burns tissue as it is divided

-Cutting current seals small spaces in the tissue and lymphatic vessels

Hazards to Patient & Surgical Team from ESU

Over time and with routine use, tiny breaks or cracks in the insulation may occur. If the instrument touches tissue distal to the operative site at the point where the insulation is not intact, the electrical current, May leak out and burn that area.

(RF) Resonant Frequency Capacitive Coupling

When an alternating current travels from the active electrode, across intact insulation, and into the skin

(Burning gloves

Dielectric Breakdown

When high voltage breaks down some insulating material

How to prevent RF capacitive coupling,

the tip of the ESU pencil should be placed below the fingers of the individual holding the clamp or forceps.

Vaporized tissue plume A>K>A (smoke and aerosolized tissue)

1. Is formed when tissue is thermally destroyed and vaporized through the use of the ESU, laser..

2. The tip of the evacuator wand should be positioned as close as possible (1 cm. or less) to the surgical site to allow maximum removal of the plume.

3. Use ULPA filters

Manipulators

-Categorized by geometrical design.

-Joints are referred to as shoulders, elbow, and wrist.

-Definite number of degrees of freedom and rotation.

•Geometry designs:

-Cartesian coordinate geometry.

-Cylindrical coordinate geometry.

-Revolute geometry

ULTRASONIC ENERGY:

(Harmonic Scalpel)

•Harmonic scalpel:

-Uses ultrasonic energy (vibrations) to cut and coagulate tissue at the point of impact.

-Precise, lower temp, less thermal damage to surrounding tissue, less plume.

-No grounding pad needed because electricity does not pass through the patient

- create a sticky coagulum that "Welds" severed ends shut

The cavitron ultrasonic surgical aspirator or "CUSA"

Is a device that uses high-frequency sound waves that create imploding bubbles to fragment and emulsify tumor tissue and leave vascular structures intact.

The acronym "laser" means

light amplification by the stimulated emission of radiation

Laser light is________________which means that the photons that compose the light are all of the same color or wavelength.

Monochromatic-

Mono-1

chromat-color

ic-pertaining to

When a laser beam contacts tissue, there are four interactions that can occur:

1. Absorption

2. Transmission

3. Reflection

4. Scattering.

4 Interactions of LASER with Tissue

1. Absorption

When the laser energy impacts the tissue -> cellular water content is heated -> causing the water to be converted to steam

- The pressure in the cell increases & eventually bursts causing laser plume

4 Interactions of LASER with Tissue

2. Transmission

When the laser energy is transmitted through a distending media

Ex: Glycine place in the bladder to vaporize bladder tumors

Advantages of Robots

1. Eliminates hand tremors for fewer errors and more precise surgeries

2. Perform complex interventions within confined space

3. Better visualization through 3-D imaging

4. Fosters telesurgery

Articulated

Separated into sections