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Chapter 14: Minimally Invasive Surgery

The most common arrhythmia seen during laparoscopy is

A. Atrial fibrilation

B. Sinus tachycardia

C. Premature ventricular contractions

D. Sinus bradycardia

Answer: D

The pressure effects of the pneumoperitoneum on cardiovascular physiology also have been studied. 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 cardiac output. This is not seen in the normovolemic patient. The most common arrhythmia created by laparoscopy is bradycardia. A rapid stretch of the peritoneal membrane often causes a vagovagal response with bradycardia and occasionally hypotension. The appropriate management of this event is desufflation of the abdomen, administration of vagolytic agents (eg, atropine), and adequate volume replacement. (See Schwartz 10th ed., p. 418.)

Capacitive coupling

A. Results when energy bleeds from a port sleeve or laparoscope into adjacent (but not touching) bowel

B. Is always recognized at the time of surgery

C. Can result in malfunction of the electrocardiogram monitor

D. Can result in inaccurate image transmission to the digital monitor

Answer: A

To avoid thermal injury to adjacent structures, the laparoscopic field of view must include all uninsulated portions of the electrosurgical electrode. In addition, the integrity of the insulation must be maintained and assured. Capacitive coupling occurs when a plastic trocar insulates the abdominal wall from the current; in turn the current is bled off a metal sleeve or laparoscope into the viscera (Fig. 14-1). This may result in thermal necrosis and a delayed fecal fistula. Another potential mechanism for unrecognized visceral injury may occur with the direct coupling of current to the laparoscope and adjacent bowel. (See Schwartz 10th ed., Figure 14-7, pp. 427–428.)


Fig. 14-1. Capacitive coupling occurs as a result of high current density bleeding from a port sleeve or laparoscope into adjacent bowel. (Reproduced with permission from Odell RC. Laparoscopic electrosurgery, in Hunter JG, Sackier JM, eds. Minimally Invasive Surgery. New York: McGraw-Hill, 1993, p 33.)

Which of the following are true regarding safe laparoscopic surgery in pregnancy.

A. The patient should be position in the left lateral position.

B. Open abdominal access (Hasson) is recommended versus direct puncture laparoscopy (Veress neelde).

C. The ...

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