Exam 7: Surgical Modalities

The new physician-owned endoscopy and surgery center opened with ample sized procedure rooms and a larger sterile storage core than the former unit.The gastroenterologists had a busy and financially profitable practice.They used the best and most expensive reusable endoscopic biopsy forceps on every gastroscopy and colonoscopy.The endoscope processing and decontamination room used the same manufacturer's endoscopic cleaning brushes on every scope.These devices received considerable use and abuse and were often discarded after one or a few uses.Based on the characteristics of the new center and the gastroenterology practice,what would be the best option for the biopsy forceps and cleaning brushes?

The surgeon used the ESU in monopolar mode to cut and coagulate through the subcutaneous tissue on opening the abdomen during a bariatric bypass procedure.As she began to proceed through the muscle and fascia layer,she asked the circulating nurse to increase the cut and Coagulation modes on the ESU.What measure could the scrub person take to enhance energy delivery?

The new general surgery fellow placed the three trocar ports for the laparoscopic appendectomy.She was focused on the concept of exact geometric triangulation of the three port accesses,to avoid the concept of sword fighting after inserting her instruments.She knew she had to proceed with caution and determination since this hospital was not able to provide the protected blade trocars she was used to using at the university medical center.The procedure was completed without incident;however,on postoperative day 1,the patient demonstrated signs and symptoms of sepsis.What might have been the unusual occurrence that could have resulted in patient sepsis?

To help visualize abdominal structures and to enhance safety during laparoscopic procedures,a pneumoperitoneum is created.After Veress needle confirmation,insufflation tubing is connected and the process begun.CO₂ gas is used to insufflate the abdominal cavity at an ideal flow rate of ___ to achieve an ideal intra-abdominal pressure of .

The perioperative manager and the nurse-educator uncrated the new cryosurgery generator on the loading dock.The generator had been ordered for the OR,but there was no information on who ordered it.The perioperative manager and nurse-educator were new in their positions in this newly opened surgical oncology inpatient unit.The machine was large and on wheels and included an adaptor for a liquid nitrogen tank and a box of protective goggles and gloves.They called Dr.Wheeler,the liver surgeon,and Dr.Chandler,the dermatology plastic surgeon,to ask if they were aware of the delivery or had ordered the device.The most obvious destination for the transfer and placement of this device,after it is uncrated,is:

The instrument tips in laparoscopic instruments are designed to produce the same tissue effects as a traditional instrument used for open surgery.Because of the process challenges of the laparoscopic approach,it is time-consuming to insert and withdraw instruments repeatedly during the procedure.Instrument manufacturers have attempted to make their products efficient by combining functions.An appropriate combined function for a laparoscopic instrument would be:

Lasers,dependent on their wavelength,can produce absorption,reflection,transmission,and scatter.The effect of scatter does not have any therapeutic benefit at this time and can be destructive to both staff and instruments.Select a safety measure that would prevent inadvertent scatter of laser energy during a surgical procedure.

MATCHING Flexible endoscopes,whether they are a fiberscope with an eyepiece lens or a videoscope,have four distinct components.Match each component with its descriptive statement by drawing a line from the component part name below to the appropriate component part on the image. a.Control body b.Insertion tube c.Light guide connector d.Bending section -Distal tip,flexible movement,lenses,air-water nozzle,CCD chip

MATCHING Flexible endoscopes,whether they are a fiberscope with an eyepiece lens or a videoscope,have four distinct components.Match each component with its descriptive statement by drawing a line from the component part name below to the appropriate component part on the image. a.Control body b.Insertion tube c.Light guide connector d.Bending section -Angulation knobs,air-water channel buttons,biopsy port

MATCHING Flexible endoscopes,whether they are a fiberscope with an eyepiece lens or a videoscope,have four distinct components.Match each component with its descriptive statement by drawing a line from the component part name below to the appropriate component part on the image. a.Control body b.Insertion tube c.Light guide connector d.Bending section -Flexible tube with channels for suction,biopsy,irrigation,light

Endoscopic instruments are designed to perform the intervention at the target tissue site through the tubular endoscope.The endoscopic instrument is considered:

An endoscope is a diagnostic or therapeutic instrument that enters the body through a:

The OR was trialling a new insufflation system and the vendor representative was out of the room taking a phone call.The perioperative nurse was concerned that the flow rate was well above 14 L/min and the pressure had risen to 16 mm Hg.She alerted the surgeon and reduced the rate and pressure because she feared that the elderly patient was at high risk for:

Select the statements that best reflect the benefits of laser surgery for the surgical services department.

The surface tissue effect of the CO₂ laser serves as the laser of choice for:

Dr.Wheeler prefers the argon beam coagulator for dissection in his liver procedures because the liver bleeds easily and traditional monopolar electrosurgery often causes more bleeding than it stops.What is the application characteristic of the argon beam coagulator that enhances liver tissue hemostasis?

The original equipment manufacturer (OEM)instructions that came with the new rigid endoscope system did not recommend a particular sterilization modality;however,high temperatures and ultrasonic cleaning were discouraged and the facility recently removed the ethylene oxide sterilizers from the sterile processing department.The perioperative nurses and surgical technologists in the minimally invasive surgery (MIS)service collaborated on developing a processing procedure for their new equipment.What modality is their best option?

Dr.Wheeler's patient,a 72-year-old man with a single early-stage liver tumor,has an implanted automatic internal defibrillator that the anesthesia provider has decided not to disarm for the procedure.What energy-generated dissection device should Dr.Wheeler use to replace the argon beam coagulator?

The light transmission through an endoscope is achieved by way of:

The new endoscopy and surgery center called in an outsource company to present the options and advantages of reprocessing single use devices at their staff meeting.Select the appropriate questions that the staff should ask before making their decision.