Minimally Invasive and Emerging Surgical Techniques
Minimally Invasive and Emerging Surgical Techniques tests laparoscopy, robotic surgery, endoscopy, and interventional procedures, including physiology and complications.
Core rules
- Pneumoperitoneum with CO2 causes hypercapnia, respiratory acidosis, increased intra-abdominal pressure, reduced venous return, and vagal bradycardia; adjust ventilation and watch hemodynamics.
- Open entry (Hasson) or optical trocar for patients with prior surgery; prevent port-site hernia by closing fascia for ports ≥10 mm.
- Laparoscopic cholecystectomy: obtain the critical view of safety; know the Strasberg classification of bile duct injury; convert early if anatomy is unclear.
- Endoscopy: screening colonoscopy, ERCP for choledocholithiasis or cholangitis, EUS for staging and biopsy.
- Robotic surgery improves dexterity but has no proven oncologic superiority for most procedures.
Worked example: During laparoscopic cholecystectomy, a patient becomes hypotensive and bradycardic after insufflation. Reasoning: increased vagal tone and reduced preload; desufflate, give atropine if needed, and reassess. Do not proceed blindly.
Traps: ignoring CO2 retention in COPD; using laparoscopy in an unstable trauma patient instead of damage-control laparotomy; failing to close 10 mm port fascia; missing a bile duct injury because the field looked dry.