Laparoscopic & Robotic

Question 1

How many degrees of freedom does the robotic arm have?

Answer 1

7

Question 2

laparoscopy entry methods (2)

Answer 2

1. closed: spring-loaded Veress needle, blind insertion, aspirate-infuse-aspirate for placement
2. open: midline vertical incision, direct vision

Question 3

intra-abdominal pressure during laparoscopy

Answer 3

maintain under 15 mmHg

Question 4

gas of choice for pneumoperitoneum

Answer 4

CO2 - noncombustible, soluble in blood, and eliminated in lungs

use with caution in patients with respiratory acidosis

can activate the sympathetic nervous system

Question 5

laparoscopy - cardiac effects

Answer 5

• arrhythmias during inflation: sudden stretch of peritoneum causes vagal response - inflate slow, anticholinergic administration, deflate
• increase in SVR (20%), MAP: due to sympathetic activation and neuroendocrine hormone release (catecholamines, RASS, ADH): causes increased workload on heart
• SV, CO: increase if pressures <15, decrease if pressures are >15: give a fluid bolus before inflation

Question 6

components of the Da Vinci Surgical System (3)

Answer 6

1. control console
2. patient side cart
3. equipment tower

Question 7

contraindications for laparoscopy (8)

Answer 7

• diaphragmatic hernia
• acute or recent MI
• severe pulmonary disease
• VP shunt
• CHF or valve disease
• CVA or cerebral aneurysm
• increased ICP
• glaucoma

Question 8

hypercapnia

Answer 8

• decreased myocardial contractility
• increase arrhythmias
• pulmonary vasoconstriction

Question 9

laparoscopy - respiratory effects

Answer 9

• diaphragm moves cephalad: caution with ETT movement
• decreased compliance, FRC and TLC
• increased peak pressures, RR and MV

Question 10

laparoscopy - renal effects

Answer 10

• decreased blood flow and urine output
• increased creatinine clearance
• increased ADH secretion

Question 11

laparoscopy - hepatic effects

Answer 11

-decreased blood flow

Question 12

requirements for robotic surgery

Answer 12

paralysis

Question 13

laparoscopy - nitrous oxide anesthesia

Answer 13

• can diffuse into abdomen and cause distension

- avoid if concern for PONV

Question 14

laparoscopy - rule of 15s

Answer 14

• less than 15 minutes operative time
• 15 degrees Trendelenburg
• 15% above IBW

Question 15

laparoscopy - DVT

Answer 15

-increased risk due to venous pooling in legs

Question 16

laparoscopy - nitrous oxide

Answer 16

-okay to use unless increased risk of PONV