MIS

• Minimally Invasive Surgery (MIS) involves performing major operations through small incisions and uses miniaturized, high-tech imaging systems to minimize trauma of surgical exposure.
• Dr. Kelling performed the first primitive Laparoscopy by placing a cystoscope within an inflated abdomen.
• The videoendoscope has changed our understanding of surgical anatomy and reshaped surgical practice.
• The Percutaneous Endoscopic Gastronomy, invented by Gauderer and Ponsky, is the first NOTES procedure that was reported in 1981.
• Dr. William Bargar and veterinarian partner Hap Paul developed the surgical robot and performed the first surgeries on animals and then humans.
• ROBODOC is a surgical robot that performs total hip and total knee replacement surgeries.
• In 1992, ROBODOC was the first robot in the United States to operate on a human patient.
• ROBODOC has performed over 28,000 orthopedic procedures worldwide.
• Advantages of Minimally Invasive Surgery (MIS) include reduced blood loss, lower complication rate, faster recovery, lesser post-op pain, shorter hospital stay, and smaller to no post-operative scars.
• Laparoscopy or Thoracoscopy involves viewing the abdominal or thoracic cavity through minimal incisions using a small diameter instrument.
• There is a difference in the approach to thoracostomy vs laparotomy due to the limited non-stretchable surroundings of the thorax and the lack of use of positive pressure.
• Benefits of hand-assisted laparoscopic surgery include minimal incision of the ports and minimal incision to allow assisting hand to get into.
• Port sizes for hand-assisted laparoscopic surgery include a primary puncture of 12 mm for placement of the stereo laparoscope and remaining trocars of 8 mm.
• Thoracoscopy often uses a different approach than laparotomy due to the limited non-stretchable surroundings of the thorax and the lack of use of positive pressure.
• Extracavitary MIS is performed in extrathoracic and extraperitoneal spaces, such as laparoscopic nephrectomy and Totally Extra-peritoneal Inguinal Hernia Repair.
• Hand-assisted laparoscopic surgery combines the tactile advantages of open surgery with minimal access of laparoscopy and thoracoscopy.
• Extracavitary endoscopic procedures use a balloon to create working space in unconventional planes, such as between the posterior rectus sheath and the rectus abdominal muscle.
• During hand-assisted laparoscopic surgery, the surgeon uses a hand to provide retraction, counter tension during mobilization of the colon from its retroperitoneal attachments, and is useful in the region of the transverse colon.
• The mechanics of hand-assisted laparoscopic surgery use an entryway for the hand that preserves the pneumoperitoneum and enables laparoscopic visualization in combination with the use of minimally invasive instruments.
• To achieve working space in the thorax without positive pressure, a double lumen ET tube is needed, where the ipsilateral lung can be deflated when the operation starts and the insufflation can be used to collapse the ipsilateral lung, increasing working field.
• Hand-assisted laparoscopic surgery is commonly used to assist with difficult cases before conversion to celiotomy is necessary and is useful in the region of the transverse colon.
• The physiology of Thoracic MIS (Thoracoscopy) is different from that of laparoscopy because of the bony confines of the thorax, it is unnecessary to use positive pressure when working in the thorax.
• In the hypovolemic individual, excessive pressure on the inferior vena cava and a reverse Trendelenburg position with loss of lower extremity muscle tone may cause decreased venous return and decreased cardiac output.
• Carbon Dioxide (CO2) is more commonly used in the Philippines because it is more inexpensive and more available.
• Pneumoperitoneum is used by surgeons in laparoscopy to have a better intraperitoneal visualization by lifting the abdominal wall from the abdominal organs through the use of CO2 and/or N2O.
• When CO2 is used, the amount of gas is constantly monitored because more than ~20-25 mmHg inside the cavity will compress the organs and cause compartment syndrome.
• The disadvantages of positive pressure in the chest wall include decreased venous return, mediastinal shift, and the need to keep a firm seal at all trocar sites.
• Surgery should be performed in the second trimester, if possible, to protect the fetus against intraoperative X-rays.
• Insufflation is when a gas is intentionally put inside the body cavity, in this case, into the abdomen causing intentional pneumoperitoneum.
• Alterations in preload are local effects (pressure specific) of CO2 peritoneum.
• CO2 gas insufflated into the peritoneal cavity has both local and systemic effects that cause a complex set of hemodynamic and metabolic alterations.
• In pregnancy, the patient should be positioned slightly on the left side to avoid compression of the vena cava by the uterus.
• In a normovolemic patient, the most common arrhythmia created by laparoscopy is bradycardia such that a rapid stretch of the peritoneal membrane often causes a vasovagal response with bradycardia and, occasionally, hypotension.
• Laparotomy is a diagnostic imaging technique.
• Access to the abdomen in the pregnant patient should take into consideration the height of the uterine fundus, which reaches the umbilicus at 20 weeks.
• Abdomen is distended by creating a pneumoperitoneum by gas insufflation and using an abdominal lift device.
• Laparotomy is a non-invasive treatment for abdominal pain.
• The physiologic effects of CO2 pneumoperitoneum can be divided into two areas: gas-specific effects and pressure specific effects.
• Laparotomy is a type of laparoscopy.
• Nitric Oxide (N2O) is less painful, physiologically inert, rapidly absorbed, provides better analgesia (under local anesthesia), and decreases intraoperative end-tidal CO2 and minute ventilation.