CIS Lesson Plans provide members with ongoing education in the complex and ever-changing area of surgical instrument care and handling. These lessons are designed for CIS technicians, but can be of value to any CRCST technician who works with surgical instrumentation.
For Online Grading (www.iahcsmm.org):
To activate a quiz:
Each lesson plan graded online with a passing score of 70% or higher is worth two points (contact hour). You can use these points toward either your re-certification of CRCST (12 points) or CIS (6 points).
Mailed submissions to IAHCSMM will not be graded and will not be granted a point value (paper/pencil grading of the CIS Lesson Plans is not available through IAHCSMM or Purdue University; IAHCSMM accepts only online subscriptions of the CIS Lesson Plans)
Newly employed Central Service technicians in many healthcare organizations are given a tour of the facility as part of their orientation process. This helps them discover the environment within which they work, and it emphasizes the significant role they will play in safeguarding the health and well-being of patients, their co-workers, and themselves. They also better understand the importance of their responsibilities as they see how instruments are actually used in surgical suites on patients, and they recognize that processing protocols must be consistently followed to make instruments safe for reuse. In this lesson, you will learn some of what those in orientation might discover about laparoscopes and their uses for several surgical procedures..
A laparoscope is one of three types of endoscopes which are tubes inserted into a body orifice or a tiny incision to access structures or internal organs. Endoscopes, such as laparoscopes (the topic of this lesson), arthroscopes, and cystoscopes, can be rigid. Endoscopes can also be flexible (examples include angioscopes, bronchoscopes, and hystereoscopes), and semi-rigid endoscopes, such as ureteroscopes, have some movement.
Laparoscopic surgery, also called “minimally invasive surgery” involves making one or more small incisions near the patient’s navel to allow a laparoscope to be inserted. Laparoscopy is also called “keyhole surgery” because surgeons use instruments manipulated from outside the patient’s body rather than their hands inside the body to perform the surgery. Note: some procedures combine the use of laparoscopic instruments with the enlargement of an incision to permit direct access (the surgeon’s hand) to the surgical site. This is necessary, for example, when the size of the organ being removed cannot be removed through the trocar (a hollow tube with a seal that prevents CO2 from leaking from the incision). Examples include removal of all or part of the colon (colectomy) and removal of the kidney (nephrectomy). Some surgeons perform these procedures with a laparoscope and then make a larger incision at the end of the procedures for organ removal. Others make a larger incision earlier in the procedure and then use their hand inside the abdomen during the surgery.
A laparoscope is comprised of a telescopic lens system that is typically connected to a video camera that projects images to one or more video monitors. It also includes a fiber optic cable system that provides “cold light” to illuminate the surgical site such as the patient’s abdominal and pelvic organs. Several types of instruments (operating tips) including scissors, graspers, forceps, and dissectors are used in the same manner as they would be used during an open procedure, but they are designed to fit through the trocar and extend into the abdominal cavity from the skin’s surface. Some laparoscopic dissectors and scissors use monopolar or bipolar electrical circuits.1
Other components of laparoscopic instruments include insufflation and suction-irrigation systems. In addition, a multi-shelf video cart contains a primary video monitor, light source, camera, printer, and insufflator. A bi-polar electrosurgical unit, post-irrigation system, and other equipment might also be included. As well, a second cart with a second monitor is normally located on the opposite side of the operating room table to allow the surgical team on that side of the table to view the procedure. Monitors are joined (connected) with a co-axial cable system.
Laparoscopic instruments may be disposable, reusable, reposable (reusable instruments with disposable cutting or coagulation tips), or a combination of these alternatives.
Laparoscopy may be performed at surgery centers or in a hospital. Local anesthesia may be used for biopsies and diagnostic procedures (removal of microscopic tissue samples), but general anesthesia is needed when operative procedures, including abdominal surgery, are being done. After the patient is anesthetized, a hollow needle is inserted into the abdomen in or near the navel, and carbon dioxide (CO2) gas is pumped through the needle to expand the abdomen. Note: the CO2 is later absorbed by the tissue and removed by the body’s respiratory system. The laparoscope is inserted through the incision, and additional small incisions may be made to insert other instruments used for specific surgical procedures.
Laparoscopy is used for numerous diagnostic purposes. For example, it is useful in taking biopsies of abdominal or pelvic growths and lymph nodes. Laparoscopic instruments can also be used to examine organs including the appendix, gall bladder, stomach, liver, and the female organs. Laparoscopy is also used for gastric bypass surgeries and to determine the causes of pelvic pain and gynecological concerns (those affecting female reproductive organs) that cannot otherwise be determined by physical exams or other methods.
Examples include ovarian cysts (bladder- like pouches containing fluids), endometriosis (a disease in which uterus-like tissue located elsewhere reacts to the menstrual cycle and causes inflammation and bleeding), and ectopic pregnancies (those which develop outside the uterus). Blocked fallopian tubes can also be diagnosed with laparoscopic instruments.
Laparoscopy is used extensively for noncancerous treatment procedures. Interestingly, it was first used (early 1970s) to treat cancer patients by observing the liver and then conducting biopsies on this organ; however, its use instead of additional (open) surgery to completely remove cancerous growth and surrounding tissues is controversial because laparoscopic procedures to remove cancerous and surrounding tumors and lymph nodes are more limited. However, it may be used to assess the spread of certain cancers.
Several advantages accrue to patients when laparoscopic (rather than traditional surgical procedures) are performed.
Laparoscopy is a relatively safe procedure but, as is true with any surgical intervention, complications can occur, and these include:
Laparoscopy is commonly used for several surgical procedures including:
What’s in the Future?
Robotically-assisted laparoscopic surgery is increasingly available. For example, surgeons can work several feet from the operating room table while seated at computerized equipment that presents a three-dimensional view of the operating field at the surgical site. They operate controls similar to “joy sticks” that move mechanical arms on a robot with specialized instruments that conduct the hand-like movements required to perform the surgery. Robotic surgery may offer a possible tactic for developing nations in which a central hospital can operate several remote machines at distant locations. As well, military personnel are interested in robotically-assisted laparoscopic surgery because mobile medical care can be provided while keeping trained doctors away from battle areas.
1 See, for example, Sue Klacik. Polar Express: Monopolar and Bipolar Instrumentation
(Part I). CIS Self-Study Lesson. Communiqué. November-December, 2008.
Monica Trepicone MS, BSN, RN
Instrument Management Systems
Carla McDermott, RN, ACE
Clinical Nurse 3
South Florida Baptist Hospital t
Plant City, FL
Jack D. Ninemeier, Ph.D.
Jack D. Ninemeier, Ph.D.
Michigan State University
East Lansing, MI.
Mary Olivera, MS, CRCST, CHL, FCS