20 Minimally Invasive Surgery
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 20.1: Minimally Invasive & Endoscopic Surgery
- 1. Describe the preparation of the patient for minimally invasive surgery (MIS)
- 2. Describe the function of each component of the imaging equipment used in MIS
- 3. Describe the surgical technique used for insufflation in laparoscopy
- 4. Describe the trocar-cannula system used in MIS
- 5. Describe the specific electrosurgical risks of direct and capacitative coupling
- 6. Describe the structure and function of a flexible endoscope
Classroom Preparation
Lesson 20.1: Minimally Invasive & Endoscopic Surgery
INSTRUCTOR PREPARATION
Textbook Objectives Covered
- 1. Describe the preparation of the patient for minimally invasive surgery (MIS)
- 2. Describe the function of each component of the imaging equipment used in MIS
- 3. Describe the surgical technique used for insufflation in laparoscopy
- 4. Describe the trocar-cannula system used in MIS
- 5. Describe the specific electrosurgical risks of direct and capacitative coupling
- 6. Describe the structure and function of a flexible endoscope
National Standards Covered
- • See the Fuller 8e/AST Core Curriculum Mapping Guide on Evolve instructor resources.
Classroom Preparation
Lesson 20.1: Minimally Invasive & Endoscopic Surgery
STUDENT PREPARATION (1 hr)
| 1 | READ – Chapter Heading(s) • Introduction • Preoperative Preparation Patient Positioning Skin Prep and Draping Maintaining Patient Normothermia Surgical Setup for MIS Conversion to an Open Case ANSWER – Textbook • Review Question 5 ANSWER – Workbook • Chapter 20 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
| 2 | READ – Chapter Heading(s) • Technology and Techniques Imaging System Equipment Cart Integrated Operating Room ANSWER – Textbook • Review Questions 1, 2, 3, 4 ANSWER – Workbook • Chapter 20 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
| 3 | READ – Chapter Heading(s) • Technology and Techniques Enhancing Visualization During MIS ANSWER – Workbook • Chapter 20 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
| 4 | READ – Chapter Heading(s) • Technology and Techniques Trocar-Cannula System Specimen Retrieval Hemostasis and Tissue Approximation • MIS Instruments Care of MIS Instruments Intraoperative Instrument Care Specialty Telescopes ANSWER – Textbook • Review Question 6 ANSWER – Workbook • Chapter 20 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
| 5 | READ – Chapter Heading(s) • Energy Sources in MIS Electrosurgical Risks Ultrasonic Energy High-Frequency Bipolar Electrosurgery Laser ANSWER – Textbook • Review Questions 7, 8 • Case Study 1 ANSWER – Workbook • Chapter 20 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
| 6 | READ – Chapter Heading(s) • Use of the Flexible Endoscope • Flexible Endoscope Echoendoscope Capsule Endoscope Imaging System Technique • Reprocessing Endoscopes and Instruments Protocols and Standards Precleaning of Rigid Endoscopes Guidelines for Precleaning Instruments Precleaning Optical Parts and Lenses Flexible Endoscope Reprocessing Disinfection and Sterilization ANSWER – Textbook • Case Study 2 ANSWER – Workbook • Chapter 20 PREPARE – Evolve Student Resources • Mock Certification Exam • Review Questions |
50-Minute Lesson Plan
Lesson 20.1: Minimally Invasive & Endoscopic Surgery
LECTURE OUTLINE (50 min)
| POWERPOINT SLIDES | CHAPTER HEADING(S) | |
| 1 | PATIENT PREPARATION: SLIDES 4-5 | • Introduction • Preoperative Preparation Patient Positioning Skin Prep and Draping Maintaining Patient Normothermia Surgical Setup for MIS Conversion to an Open Case |
| 2 | IMAGING EQUIPMENT: SLIDE 6 | • Technology and Techniques Imaging System Equipment Cart Integrated Operating Room |
| 3 | INSUFFLATION AND LAPAROSCOPY: SLIDES 7-8 | Technology and Techniques Enhancing Visualization During MIS |
| 4 | TROCAR-CANNULA SYSTEM: SLIDES 9-10 | • Technology and Techniques Trocar-Cannula System Specimen Retrieval Hemostasis and Tissue Approximation • MIS Instruments Care of MIS Instruments Intraoperative Instrument Care Specialty Telescopes |
| 5 | ELECTROSURGICAL RISKS: SLIDES 11-12 | • Energy Sources in MIS Electrosurgical Risks Ultrasonic Energy High-Frequency Bipolar Electrosurgery Laser |
| 6 | FLEXIBLE ENDOSCOPE: SLIDES 14 | • Use of the Flexible Endoscope • Flexible Endoscope Echoendoscope Capsule Endoscope Imaging System Technique • Reprocessing Endoscopes and Instruments Protocols and Standards Precleaning of Rigid Endoscopes Guidelines for Precleaning Instruments Precleaning Optical Parts and Lenses Flexible Endoscope Reprocessing Disinfection and Sterilization |
Learning Activities (choose one or more to equal 50 min)
| 1 | DEMONSTRATE (50 min) • Demonstrate to the students the steps of MIS patient prep. Afterward, allow them to act out these steps, rotating roles as they go. • Appropriate Settings: Traditional classroom DISCUSS (30 min) • Compare and contrast the setup of an open procedure with that of an endoscopic procedure using two columns on the board. (Some of these steps might be the same for the two surgery types.) Include the following steps in your discussion: • Preparation of patient • Preparation of nonsterile equipment • Preparation of sutures • Preparation of instruments • Preparation of solutions and drugs. • Appropriate Settings: Traditional/online/flipped classroom |
| 2 | DISCUSS (30 min) • Review the steps for preparing and using the fiberoptic light source. Include the following questions in the review: • What is the main hazard posed by the light source? How can this be controlled? • What is the main type of damage that can occur with this type of light source? How can it be prevented? • Appropriate Settings: Traditional/online/flipped classroom |
| 3 | DISCUSS (30 min) • Have small groups of students draw flowcharts describing one of the two primary methods for creating the pneumoperitoneum (assign each group either the Veress needle method or the Hasson cannula method). Ask one group to present its chart, and then ask others to add to or modify the explanation. • Appropriate Settings: Traditional/online/flipped classroom DEMONSTRATE (50 min) • Demonstrate to the students the surgical technique used for insufflations in laparoscopy. If time permits, allow them to practice the technique. Appropriate Settings: Traditional classroom |
| 4 | PRACTICE (50 min) • Provide examples of the trocar-cannula system for students to view and handle. If time allows, practice passing the instruments as well. Another option would be to insert trocars into a cardboard box and pass the instruments through them. Appropriate Settings: Traditional classroom |
| 5 | REVIEW (30 min) • Review the list of patient risks during electrosurgical procedures in the textbook. Have a different student read each risk aloud, then call on students to explain what steps are taken to minimize that risk. Note the risk and the preventive measure side by side on the board, and highlight those measures performed (all or in part) by the surgical technologist. Appropriate Settings: Traditional/online/flipped classroom |
| 6 | DISCUSS (30 min) • Divide the class into groups and assign each one a type of instrument. Ask each group to summarize the uses and appropriate care of their instrument. Have each group present its summary to the class. • Discuss as a class the proper protocol for processing rigid and flexible endoscopes. • Appropriate Settings: Traditional/online/flipped classroom INVITE (50 min) • Invite a regional endoscope salesperson for a class demonstration. Appropriate Settings: Traditional classroom |
Critical Thinking Question
Endoscopic procedures generally provide shorter and less painful recovery time for the patient. However, there will always be a need for traditional “open” surgical procedures. What types of procedures are not likely to ever be replaced by endoscopy? Are there patients for whom endoscopy might not be a viable option even if the surgery is possible?
Discussion Guidelines: Students might discuss that one of the key characteristics of endoscopy is the small incision. Surgeries in which something large is either taken out (e.g., a baby) or put in (e.g., a transplanted organ) could not be replaced by completely endoscopic procedures. When thinking about patients, students might note the extreme body positions often required for endoscopy. Patients who are likely to be injured by these positions might not be suitable candidates for endoscopy.
You are setting up instruments for an endoscopic procedure and accidentally drop several instruments on the sterile back table. As you are picking them up, you see what might be a small crack in the insulation on one of the forceps. What do you do?
Discussion Guidelines: Students might discuss the risk of a patient burn from even a small crack or blemish in the instrument’s insulation if it is used during electrosurgery. If the forceps are designed to be electrosurgically capable (as this type is), it is risky to keep a defective pair on the sterile field with the assumption that the surgeon won’t be using it in that way. The instrument should be removed from the sterile field and identified as needing to be repaired or discarded.
Assessments
Chapter 20: Minimally Invasive Surgery
ASSESSMENTS BY OBJECTIVE
| 1-6 | Workbook • Chapter 20 Evolve Instructor Resources • Test Bank Create a quiz using ExamView; sort by objective. Evolve Student Resources • Mock Certification Exam • Review Questions |
| All | Elsevier Adaptive Quizzing • Chapter 20 – Graded quizzes (Mastery Levels 1, 2, and 3) |
