Minimally Invasive Surgery (MIS), Robotics, and Navigation Flashcards

Flashcards covering key concepts, components, procedures, advantages, and risks related to Minimally Invasive Surgery (MIS), Robotics, and Navigation based on lecture notes.

What are the common applications of Minimally Invasive Surgery (MIS) systems?

Endoscopy, Robotics, and Navigation.

What is the definition of endoscopy in the context of MIS?

Any type of MIS procedure where a lensed telescope is used.

What is the definition of laparoscopy?

Endoscopic visualization of the peritoneal cavity through the anterior abdominal wall after the establishment of a pneumoperitoneum.

What are the fundamental principles of Minimally Invasive Surgery (MIS)?

Telescopic viewing, cannula insertion, protection of the body wall, creation of a protective seal, and manipulation of telescopic instruments.

Which primary components make up standard MIS equipment?

Telescopic instruments, cannulas, an imaging system, and a method of expanding body spaces or tissue planes.

What components constitute the imaging system used in MIS?

A light source, light cable, surgical telescope (endoscope), camera head, camera control unit, video cables, monitor screen, and image management system.

What is a crucial safety guideline for handling fiberoptic cables?

Handle cables gently by coiling loosely and avoid striking them on hard surfaces to prevent fiberoptic bundles from fracturing.

What is meant by the 'optical angle' of a rigid telescope?

It is the direction in which the lenses are focused on the image.

Why is it important to white-balance the camera before each MIS procedure?

This procedure adjusts the light color to match the other components in the system, ensuring accurate image display.

What is the primary function of the trocar-cannula system in MIS?

It is used to create ports or channels, introduce instruments, provide a seal, and protect body tissues.

What are the typical size ranges for trocars in adult MIS procedures?

Adult trocars generally range from 5-10 mm, with large and special-purpose ones up to 10-15 mm.

What gas is commonly used for insufflation in MIS procedures, and why?

Carbon dioxide (CO2) is used because it is readily absorbed by the body, is nontoxic, and nonflammable.

What is the recommended intraoperative pressure for pneumoperitoneum?

12 to 18 mm Hg.

Why is carbon dioxide gas warmed before insufflation for pneumoperitoneum?

Warming the CO2 maintains the patient’s core temperature and prevents fogging of the telescope lens.

What is 'intravasation' in the context of continuous irrigation during MIS?

It is the risk of irrigation fluids being absorbed into the vascular system, which can increase blood pressure or cause electrolyte imbalance.

What is the purpose of balloon dissection in MIS?

To create anatomical space in tissue planes by separating tissue layers with a plastic balloon.

Differentiate between extracorporeal and intracorporeal suture techniques in MIS.

In extracorporeal, the knot is tied outside the body cavity and pushed into place with a knot pusher. In intracorporeal, the suture is knotted and tightened inside the body with two grasping instruments.

What are the common energy sources utilized in MIS for tissue coagulation and cutting?

Ultrasonic energy, high-frequency bipolar electrosurgery, and laser.

When should MIS instruments be inspected?

Before use, during use, after use, after decontamination, and before disinfection and sterilization.

What are the common specialized telescopes used in various MIS procedures?

Laparoscope, Arthroscope, Hysteroscope, Thoracoscope, Nephroscope, Cystourethroscope, and Resectoscope.

What methods are used for specimen retrieval in MIS?

Morcellation, retractable tissue bags (Endobags), and tissue shaving.

What are the key advantages of Minimally Invasive Surgery (MIS)?

Decreased tissue trauma, reduced blood loss, faster recovery, suitability for outpatient procedures, decreased pain, increased patient satisfaction, and often less cost.

What are some limitations of MIS?

Steep learning curves for surgeons, potential vision system errors, expensive instrumentation and equipment, and not all patients are suitable candidates.

Why are patients with previous abdominal procedures often not good candidates for MIS?

They have a high risk of abdominal adhesions (scarring), which presents a risk of perforation as the trocar and cannula are advanced.

What are significant electrosurgical risks associated with MIS?

Insulation failure, direct coupling, and capacitative coupling.

What is the most effective way to prevent electrosurgical burns in MIS?

Active electrode monitoring systems.

What is the primary use of flexible endoscopes?

Examination or visual exploration and biopsy within body passages or organs.

Define Robotic-Assisted Surgery (RAS).

A minimally-invasive surgical system enabled by robotic technology where actions are under the direct control of the surgeon.

What does 'degrees of freedom' refer to in robotic terminology?

The number of ways that a robot manipulator can move in three dimensions, including clockwise, counter-clockwise, grip, insertion, pitch, roll, and yaw.

What is 'haptic feedback' in surgical robotics, and what is its significance?

It refers to the sense of touch transmitted to the surgeon's hand. Its absence (in some systems) means the surgeon must rely on vision alone during remote instrument manipulation.

What are the main components of a robotic surgical system?

A surgeon console, a bedside unit (patient cart) with instrument arms, and an imaging system (vision tower).

List some advantages of robotic surgery over traditional MIS.

It provides 3-dimensional images, reduces tremor and movement scale, and allows movements that closely replicate human motion.

What are the disadvantages of robotic surgery?

It is expensive, uses valuable resources, requires an on-site coordinator, necessitates specialized surgeon training, and often lacks haptic feedback.

What is the role of the surgeon during a robotic-assisted surgery?

The surgeon performs sterile techniques to place trocars, then breaks scrub to operate from the console, directs the flow of the procedure, and returns to the sterile field to remove trocars and close incisions.

What is a Navigation System in surgery?

It acts as a 'GPS for surgery,' using a 3D coordinate system to guide the surgeon to a specific location in tissue, often planned using preoperative images like CT, MRI, or ultrasound.

What are 'fiducial markers' used for in navigation systems?

They are used to help pinpoint the location of a tumor or other target areas for precise surgical guidance.

What is the 'O-arm' in surgical imaging?

It is an intraoperative 2D/3D imaging system used to provide real-time anatomical visualization during surgery.

What are the common applications of Minimally Invasive Surgery (MIS) systems?

Endoscopy, Robotics, and Navigation.

What is the definition of endoscopy in the context of MIS?

Any type of MIS procedure where a lensed telescope is used.

What is the definition of laparoscopy?

Endoscopic visualization of the peritoneal cavity through the anterior abdominal wall after the establishment of a pneumoperitoneum.

What are the fundamental principles of Minimally Invasive Surgery (MIS)?

Telescopic viewing, cannula insertion, protection of the body wall, creation of a protective seal, and manipulation of telescopic instruments.

Which primary components make up standard MIS equipment?

Telescopic instruments, cannulas, an imaging system, and a method of expanding body spaces or tissue planes.

What components constitute the imaging system used in MIS?

A light source, light cable, surgical telescope (endoscope), camera head, camera control unit, video cables, monitor screen, and image management system.

What is a crucial safety guideline for handling fiberoptic cables?

Handle cables gently by coiling loosely and avoid striking them on hard surfaces to prevent fiberoptic bundles from fracturing.

What is meant by the 'optical angle' of a rigid telescope?

It is the direction in which the lenses are focused on the image.

Why is it important to white-balance the camera before each MIS procedure?

This procedure adjusts the light color to match the other components in the system, ensuring accurate image display.

What is the primary function of the trocar-cannula system in MIS?

It is used to create ports or channels, introduce instruments, provide a seal, and protect body tissues.

What are the typical size ranges for trocars in adult MIS procedures?

Adult trocars generally range from 5-10 mm, with large and special-purpose ones up to 10-15 mm.

What gas is commonly used for insufflation in MIS procedures, and why?

Carbon dioxide (CO2) is used because it is readily absorbed by the body, is nontoxic, and nonflammable.

What is the recommended intraoperative pressure for pneumoperitoneum?

12 to 18 mm Hg.

Why is carbon dioxide gas warmed before insufflation for pneumoperitoneum?

Warming the CO2 maintains the patient’s core temperature and prevents fogging of the telescope lens.

What is 'intravasation' in the context of continuous irrigation during MIS?

It is the risk of irrigation fluids being absorbed into the vascular system, which can increase blood pressure or cause electrolyte imbalance.

What is the purpose of balloon dissection in MIS?

To create anatomical space in tissue planes by separating tissue layers with a plastic balloon.

Differentiate between extracorporeal and intracorporeal suture techniques in MIS.

In extracorporeal, the knot is tied outside the body cavity and pushed into place with a knot pusher. In intracorporeal, the suture is knotted and tightened inside the body with two grasping instruments.

What are the common energy sources utilized in MIS for tissue coagulation and cutting?

Ultrasonic energy, high-frequency bipolar electrosurgery, and laser.

When should MIS instruments be inspected?

Before use, during use, after use, after decontamination, and before disinfection and sterilization.

What are the common specialized telescopes used in various MIS procedures?

Laparoscope, Arthroscope, Hysteroscope, Thoracoscope, Nephroscope, Cystourethroscope, and Resectoscope.

What methods are used for specimen retrieval in MIS?

Morcellation, retractable tissue bags (Endobags), and tissue shaving.

What are the key advantages of Minimally Invasive Surgery (MIS)?

Decreased tissue trauma, reduced blood loss, faster recovery, suitability for outpatient procedures, decreased pain, increased patient satisfaction, and often less cost.

What are some limitations of MIS?

Steep learning curves for surgeons, potential vision system errors, expensive instrumentation and equipment, and not all patients are suitable candidates.

Why are patients with previous abdominal procedures often not good candidates for MIS?

They have a high risk of abdominal adhesions (scarring), which presents a risk of perforation as the trocar and cannula are advanced.

What are significant electrosurgical risks associated with MIS?

Insulation failure, direct coupling, and capacitative coupling.

What is the most effective way to prevent electrosurgical burns in MIS?

Active electrode monitoring systems.

What is the primary use of flexible endoscopes?

Examination or visual exploration and biopsy within body passages or organs.

Define Robotic-Assisted Surgery (RAS).

A minimally-invasive surgical system enabled by robotic technology where actions are under the direct control of the surgeon.

What does 'degrees of freedom' refer to in robotic terminology?

The number of ways that a robot manipulator can move in three dimensions, including clockwise, counter-clockwise, grip, insertion, pitch, roll, and yaw.

What is 'haptic feedback' in surgical robotics, and what is its significance?

It refers to the sense of touch transmitted to the surgeon's hand. Its absence (in some systems) means the surgeon must rely on vision alone during remote instrument manipulation.

What are the main components of a robotic surgical system?

A surgeon console, a bedside unit (patient cart) with instrument arms, and an imaging system (vision tower).

List some advantages of robotic surgery over traditional MIS.

It provides 3-dimensional images, reduces tremor and movement scale, and allows movements that closely replicate human motion.

What are the disadvantages of robotic surgery?

It is expensive, uses valuable resources, requires an on-site coordinator, necessitates specialized surgeon training, and often lacks haptic feedback.

What is the role of the surgeon during a robotic-assisted surgery?

The surgeon performs sterile techniques to place trocars, then breaks scrub to operate from the console, directs the flow of the procedure, and returns to the sterile field to remove trocars and close incisions.

What is a Navigation System in surgery?

It acts as a 'GPS for surgery,' using a 3D coordinate system to guide the surgeon to a specific location in tissue, often planned using preoperative images like CT, MRI, or ultrasound.

What are 'fiducial markers' used for in navigation systems?

They are used to help pinpoint the location of a tumor or other target areas for precise surgical guidance.

What is the 'O-arm' in surgical imaging?

It is an intraoperative 2D/3D imaging system used to provide real-time anatomical visualization during surgery.

What is the primary benefit of a 30-degree rigid endoscope compared to a 0-degree endoscope in MIS?

It allows the surgeon to visualize structures not in a direct line with the port, providing an angled view and reducing the need for additional port sites.

What is the main purpose of creating a pneumoperitoneum during laparoscopic surgery?

To create a safe and ample working space within the abdominal cavity, allowing for better visualization and manipulation of surgical instruments.

What are the two primary methods for establishing pneumoperitoneum in laparoscopic surgery?

1. Veress Needle Technique: A blind insertion technique where a spring-loaded needle is used to insufflate gas.

2. Hasson (Open) Technique: Involves a small incision and direct visualization to place the trocar, often preferred in patients with prior abdominal surgeries.

What are the two main types of electrosurgical current used for tissue manipulation in MIS?

1. Monopolar Electrosurgery: Current flows from an active electrode through the patient to a return electrode pad.

2. Bipolar Electrosurgery: Current flows between two electrodes at the surgical site, confining the current.

What is the function of the internal valve mechanism within a cannula?

It creates a seal to prevent the escape of insufflation gas (e.g., CO2) from the body cavity, maintaining pneumoperitoneum, and accommodating instruments of various sizes.

What are the common applications of Minimally Invasive Surgery (MIS) systems?

Endoscopy, Robotics, and Navigation.

What is the definition of endoscopy in the context of MIS?

Any type of MIS procedure where a lensed telescope is used.

What is the definition of laparoscopy?

Endoscopic visualization of the peritoneal cavity through the anterior abdominal wall after the establishment of a pneumoperitoneum.

What are the fundamental principles of Minimally Invasive Surgery (MIS)?

Telescopic viewing, cannula insertion, protection of the body wall, creation of a protective seal, and manipulation of telescopic instruments.

Which primary components make up standard MIS equipment?

Telescopic instruments, cannulas, an imaging system, and a method of expanding body spaces or tissue planes.

What components constitute the imaging system used in MIS?

A light source, light cable, surgical telescope (endoscope), camera head, camera control unit, video cables, monitor screen, and image management system.

What is a crucial safety guideline for handling fiberoptic cables?

Handle cables gently by coiling loosely and avoid striking them on hard surfaces to prevent fiberoptic bundles from fracturing.

What is meant by the 'optical angle' of a rigid telescope?

It is the direction in which the lenses are focused on the image.

Why is it important to white-balance the camera before each MIS procedure?

This procedure adjusts the light color to match the other components in the system, ensuring accurate image display.

What is the primary function of the trocar-cannula system in MIS?

It is used to create ports or channels, introduce instruments, provide a seal, and protect body tissues.

What are the typical size ranges for trocars in adult MIS procedures?

Adult trocars generally range from 5-10 mm, with large and special-purpose ones up to 10-15 mm.

What gas is commonly used for insufflation in MIS procedures, and why?

Carbon dioxide (CO2) is used because it is readily absorbed by the body, is nontoxic, and nonflammable.

What is the recommended intraoperative pressure for pneumoperitoneum?

12 to 18 mm Hg.

Why is carbon dioxide gas warmed before insufflation for pneumoperitoneum?

Warming the CO2 maintains the patient’s core temperature and prevents fogging of the telescope lens.

What is 'intravasation' in the context of continuous irrigation during MIS?

It is the risk of irrigation fluids being absorbed into the vascular system, which can increase blood pressure or cause electrolyte imbalance.

What is the purpose of balloon dissection in MIS?

To create anatomical space in tissue planes by separating tissue layers with a plastic balloon.

Differentiate between extracorporeal and intracorporeal suture techniques in MIS.

In extracorporeal, the knot is tied outside the body cavity and pushed into place with a knot pusher. In intracorporeal, the suture is knotted and tightened inside the body with two grasping instruments.

What are the common energy sources utilized in MIS for tissue coagulation and cutting?

Ultrasonic energy, high-frequency bipolar electrosurgery, and laser.

When should MIS instruments be inspected?

Before use, during use, after use, after decontamination, and before disinfection and sterilization.

What are the common specialized telescopes used in various MIS procedures?

Laparoscope, Arthroscope, Hysteroscope, Thoracoscope, Nephroscope, Cystourethroscope, and Resectoscope.

What methods are used for specimen retrieval in MIS?

Morcellation, retractable tissue bags (Endobags), and tissue shaving.