{"id":777,"date":"2022-11-30T17:41:29","date_gmt":"2022-11-30T17:41:29","guid":{"rendered":"https:\/\/perioperative1000.slc-courses.ca\/?p=777"},"modified":"2022-11-30T17:46:15","modified_gmt":"2022-11-30T17:46:15","slug":"module-7-f-setting-up-the-perioperative-environment-for-minimally-invasive-procedures","status":"publish","type":"post","link":"https:\/\/perioperative1000.slc-courses.ca\/?p=777","title":{"rendered":"Module 7: F. Setting up the Perioperative Environment for Minimally Invasive Procedures"},"content":{"rendered":"\n<div class=\"wp-container-3 wp-block-columns\">\n<div class=\"wp-container-1 wp-block-column\">\n<h2>Setting up the Perioperative Environment for Minimally Invasive Procedures<\/h2>\n<\/div>\n\n\n\n<div class=\"wp-container-2 wp-block-column\">\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Basic Laparoscopic Surgery\" width=\"580\" height=\"326\" src=\"https:\/\/www.youtube.com\/embed\/sPyZRkkxqNs?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n<\/div>\n<\/div>\n\n\n\n<h5>Insufflation and Pneumoperitoneum<\/h5>\n\n\n\n<p>\n  For the surgeon to visualize organs and tissue within the abdominal cavity, a pneumoperitoneum must be created. The steps for this are as follows:\n<\/p>\n\n\n\n<p>\n  Step 1: A small incision is made near the umbilicus and a Veress needle is inserted into the abdomen. \n<\/p>\n\n\n\n<ol><li>     To prevent injury to internal organs, the <a id=\"post-638-_Int_lDEFzWHs\"><\/a>surgeon pulls <a id=\"post-638-_Int_MZIGLqz7\"><\/a>up abdominal <a id=\"post-638-_Int_SR1bKbE1\"><\/a>tissue while inserting the Veress needle.   <\/li><li>     To decrease the risk of perforating the bladder, patients are asked to void immediately prior to surgery, or a catheter can be inserted to empty the bladder.   <\/li><li>      <a id=\"post-638-_Int_CdxDb5aX\"><\/a>Patients are placed into the Trendelenburg position to allow all abdominal organs to shift out of the way.   <\/li><\/ol>\n\n\n\n<p>\n  Step 2: The surgeon passes the needle at a 45-degree angle as it enters. The proper placement is confirmed by connecting a syringe with saline and ensuring no resistance, as well as negative bowel and blood return on aspiration.\n<\/p>\n\n\n\n<p>   Step 3: Once the placement is confirmed, the surgeon connects the insufflation <a id=\"post-638-_Int_jhwP8NJv\"><\/a>tubing, and the circulating nurse turns on the CO2 gas at a low flow rate. <\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h5>   Why use CO2 gas? <\/h5>\n\n\n\n<ol><li><a id=\"post-638-_Int_xmdbR5F9\"><\/a>     It is not combustible.    <\/li><li>     It can be absorbed by the body at high volumes without negative consequences.   <\/li><li><a id=\"post-638-_Int_sd5M0yF2\"><\/a>     It is inexpensive.   <\/li><\/ol>\n\n\n\n<p>\n  Step 4: If the cavity fills without any issues, the circulating nurse is then asked to turn the flow rate up to higher volumes until the intrabdominal pressure reaches 14-<a id=\"post-638-_Int_D20wpPzG\"><\/a>16mm (about 0.63 in) Hg. The flow rate should ideally be at least 9L\/min <a id=\"post-638-_Int_LRy8VYHH\"><\/a>to help maintain the pressure despite gas leaks from instrument changing, smoke evacuation, or other leaks.\n<\/p>\n\n\n\n<p>\n  (Ball, 2019)\n<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<div class=\"wp-container-6 wp-block-columns\">\n<div class=\"wp-container-4 wp-block-column\">\n<h5>Risks of Pneumoperitoneum<\/h5>\n\n\n\n<p><strong>   The excess pressure from CO2 <\/strong><\/p>\n\n\n\n<ol><li>     Can cause CO2 to diffuse into the blood which can cause hypercarbia. The anesthetist monitors the end-tidal CO2 closely during laparoscopic cases <a id=\"post-638-_Int_aOJkLbDl\"><\/a>to detect increased levels of CO2.   <\/li><li>     Can also increase a patient\u2019s risk of aspirating stomach contents as the pressure can cause gastric regurgitation.   <\/li><li>     Reduces intrathoracic space which can impact a patient\u2019s respiratory effort and decrease cardiac output.   <\/li><li>     Can cause irritation of the phrenic nerve which can lead to severe postoperative pain in the shoulder and neck.   <\/li><\/ol>\n\n\n\n<p><strong>   What can be <a id=\"post-638-_Int_PmgFkIXD\"><\/a>done to reduce excess pressure from CO2? <\/strong><\/p>\n\n\n\n<ol><li>     Ensure that as much residual CO2 gas is removed at the end of the case before trocars are removed.   <\/li><li>     When possible, use insufflators or smoke evacuator systems that can monitor and alert to high pressures, or can automatically vent excess CO2 gases.   <\/li><\/ol>\n<\/div>\n\n\n\n<div class=\"wp-container-5 wp-block-column\">\n<h2 class=\"alignwide\"><img loading=\"lazy\" width=\"2309\" height=\"1299\" src=\"https:\/\/perioperative1000.slc-courses.ca\/wp-content\/uploads\/2022\/11\/word-image-638-23.jpeg\" class=\"wp-image-710\" srcset=\"https:\/\/perioperative1000.slc-courses.ca\/wp-content\/uploads\/2022\/11\/word-image-638-23.jpeg 2309w, https:\/\/perioperative1000.slc-courses.ca\/wp-content\/uploads\/2022\/11\/word-image-638-23-300x169.jpeg 300w, https:\/\/perioperative1000.slc-courses.ca\/wp-content\/uploads\/2022\/11\/word-image-638-23-1024x576.jpeg 1024w, https:\/\/perioperative1000.slc-courses.ca\/wp-content\/uploads\/2022\/11\/word-image-638-23-768x432.jpeg 768w, https:\/\/perioperative1000.slc-courses.ca\/wp-content\/uploads\/2022\/11\/word-image-638-23-1536x864.jpeg 1536w, https:\/\/perioperative1000.slc-courses.ca\/wp-content\/uploads\/2022\/11\/word-image-638-23-2048x1152.jpeg 2048w, https:\/\/perioperative1000.slc-courses.ca\/wp-content\/uploads\/2022\/11\/word-image-638-23-1200x675.jpeg 1200w, https:\/\/perioperative1000.slc-courses.ca\/wp-content\/uploads\/2022\/11\/word-image-638-23-1980x1114.jpeg 1980w\" sizes=\"(max-width: 2309px) 100vw, 2309px\" \/><\/h2>\n<\/div>\n<\/div>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h5>Preventing Gas Contamination<\/h5>\n\n\n\n<p><a id=\"post-638-_Int_DaaD5OOE\"><\/a>\n  To prevent CO2 gas tank contaminants from entering a patient, all CO2 insufflation tubing must incorporate a single-use disposable filter. This filter is hydrophobic and has two ways of preventing contamination:\n<\/p>\n\n\n\n<ol><li>     Prevents microorganisms coming from the patient from entering the CO2 tank, and   <\/li><li>      Prevents contaminants such as chromium particles from crossing from the CO2 tank into the patient.   <\/li><\/ol>\n\n\n\n<p>   (Ball, 2019) <\/p>\n","protected":false},"excerpt":{"rendered":"<p>Setting up the Perioperative Environment for Minimally Invasive Procedures Insufflation and Pneumoperitoneum For the surgeon to visualize organs and tissue within the abdominal cavity, a pneumoperitoneum must be created. The steps for this are as follows: Step 1: A small incision is made near the umbilicus and a Veress needle is inserted into the abdomen. [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"templates\/template-content.php","format":"standard","meta":[],"categories":[19],"tags":[],"wf_post_folders":[8],"_links":{"self":[{"href":"https:\/\/perioperative1000.slc-courses.ca\/index.php?rest_route=\/wp\/v2\/posts\/777"}],"collection":[{"href":"https:\/\/perioperative1000.slc-courses.ca\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/perioperative1000.slc-courses.ca\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/perioperative1000.slc-courses.ca\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/perioperative1000.slc-courses.ca\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=777"}],"version-history":[{"count":2,"href":"https:\/\/perioperative1000.slc-courses.ca\/index.php?rest_route=\/wp\/v2\/posts\/777\/revisions"}],"predecessor-version":[{"id":792,"href":"https:\/\/perioperative1000.slc-courses.ca\/index.php?rest_route=\/wp\/v2\/posts\/777\/revisions\/792"}],"wp:attachment":[{"href":"https:\/\/perioperative1000.slc-courses.ca\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=777"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/perioperative1000.slc-courses.ca\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=777"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/perioperative1000.slc-courses.ca\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=777"},{"taxonomy":"wf_post_folders","embeddable":true,"href":"https:\/\/perioperative1000.slc-courses.ca\/index.php?rest_route=%2Fwp%2Fv2%2Fwf_post_folders&post=777"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}