Chapter 07 Surgical Modalities

Chapter 07  Surgical Modalities

MULTIPLE CHOICE

1. An endoscope is a diagnostic or therapeutic instrument that enters the body through a: a. natural orifice.
b. small incision into a body compartment.
c. externalized sinus tract.

d. All of the options are correct.

ANS: D
An endoscope is a tube inserted into a natural body orifice or through a small incision to access internal organs or structures. Endoscopes are flexible, rigid, or semirigid. Flexible endoscopes include angioscopes, bronchoscopes, choledochoscopes, colonoscopes, cystonephroscopes, hysteroscopes, mediastinoscopes, ureteroscopes, and ureteropyeloscopes. Rigid endoscopes include cystoscopes, laparoscopes, sinuscopes, arthroscopes, bronchoscopes, laryngoscopes, and hysteroscopes.

REF: Page 204

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

1. a charge-coupled device chip in the tip of the scope.
2. a chain of small connected micro light bulbs.
3. bundles of fiberoptic glass rods.
4. electrified silicon cables.

ANS: C
Endoscopic light is often referred to as cold light, meaning that the heat from the light source is not transmitted through the length of the scope. Fiberoptic endoscopes have an eyepiece with a lens for visualization; the image is carried through the endoscope via a bundle of tiny glass fibers. In 1966 the rod-lens system designed by the British optical physicist Hopkins improved brightness and clarity.

REF: Pages 204-205

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

1. an instrument on a stick.
2. an extension of the surgeon’s hand.
3. a means to perform hands-free surgery.
4. surgery without tactile sensation.

ANS: B

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 7-2

Endoscopic minimally invasive surgery (MIS) instrumentation has been designed to correspond with the surgical site and the technique used while functioning as an extension of the surgeon’s hand. The length and working end of the instrument must be adequate to perform surgery at the target site.

REF: Page 206

4. Flexible fiberscopes and flexible videoscopes share many of the same components; however, in a video gastroscope, the eyepiece and lens of the fiberscope are replaced by a:

1. CCD image intensifier.
2. high-definition monitor.
3. video camera.
4. light-guided sensor.

ANS: C
There are two types of flexible endoscopes: fiberoptic endoscopes and videoscopes. Fiberoptic endoscopes have an eyepiece with a lens for visualization; the image is carried through the endoscope via a bundle of tiny glass fibers. Videoscopes have, at their distal end, a video chip that provides an image that is directly viewed on a monitor; a videoscope does not have an eyepiece for direct viewing; the eyepiece is replaced with an endoscopic video camera.

REF: Page 204

5. The design of laparoscopic instruments aims to provide a clamping, cutting, dissecting, electrocoagulating, suturing, or stapling instrument on the tip of a shaft that is long or short enough to reach the target tissue. The hand control on the surgeon’s end of the instrument is engineered to provide:

1. ergonomic comfort and control.
2. smooth operation of the lubricated instrument tips to prevent tissue adherence or

   entrapment.

3. a perception of haptic and tactile sense to prevent crushing or losing tissue.
4. adaptors for monopolar electrosurgery connection and laser fibers.

ANS: A
The length and working end of the instrument must be adequate to perform surgery at the target site. The hand control is ergonomically designed for the operator’s maximum comfort and reduced fatigue. Graspers and other instrumentation used by the assistant in surgery often are built for a shorter hand span because many women function in this role.

REF: Page 206

6. 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:

a. ultrasound capability in a suturing forceps.
Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 7-3

2. electrosurgery conduction through the tips of a Babcock grasper.
3. blunt dissection with the smooth, rounded edge of the closed endoscopic scissors.
4. suction and irrigation combined with an argon beam coagulation handpiece.

ANS: C
Dissecting instruments are used to cut, divide, or separate tissue. Scissors and dissectors that are similar to their open-procedure counterparts have been designed for use in MIS procedures. Scissors are available for blunt or sharp dissection. They can be straight or curved (including hook scissors), depending on the location of the target tissue and technique used. Scissors usually have a rounded tip when closed so that they also can be used to manipulate tissue without trauma. When open, both jaws of the scissors should be visualized to prevent inadvertent injury. Some scissors are designed to be connected to an electrosurgical energy source so that coagulation can be provided during cutting. Dissectors are used to separate or divide tissue. Many different tip shapes are available to dissect, spread, divide, grasp, retract, and coagulate structures.

REF: Page 206