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CIS Self-Study Lesson Plan

Lesson No. CIS 243 (Instrument Continuing Education - ICE) by Carla McDermott, RN, CNOR, CRCST,
Clinical Nurse III
Sponsored by: South Florida Baptist Hospital, Plant City, FL

LAPAROSCOPIC AND ROBOTIC
SURGICAL INSTRUMENTS
L
LEARNING OBJECTIVES APAROSCOPIC AND ROBOTIC INSTRUMENTATION IS COMMONLY
1. Discuss the similarities of and used in gynecological, thoracic/cardiac, general, and urological surgeries
differences between laparoscopic and in the United States. Patients are increasingly educated about these alterna-
robotic instrumentation tives and are requesting use of these procedures because of their advantages,
2. Review the importance of following including more precision, less pain, and faster healing time. This lesson explores how
manufacturer instructions for cleaning, this technology impacts the work of Central Service (CS) professionals and is import-
testing, and sterilizing laparoscopic and ant because the instrumentation has evolved through several “generations.” While each
robotic instrumentation has its own advantages and disadvantages, newer versions have more complex designs
3. Discuss the critical need for thorough and functions, and greater care and attention to detail is needed to effectively reprocess
inspection and testing of instrument these instruments.
insulation coatings
4. Explain how Central Service
professionals impact patient and OBJECTIVE 1: DISCUSS THE screens of a three-dimensional work
surgical team member safety during SIMILARITIES OF AND DIFFERENC- space in the patient’s abdomen or chest.
laparoscopic and robotic surgeries ES BETWEEN LAPAROSCOPIC AND Laparoscopic instruments are limited in
ROBOTIC INSTRUMENTATION their movements and depend on the sur-
Instrument Continuing Education (ICE) lessons Laparoscopic and robotic instruments are geons’ and assistants’ hands for mobility
provide members with ongoing education in surgical devices that are inserted via ports and function. The laparoscopic operating
the complex and ever-changing area of surgical
instrument care and handling. These lessons are
placed by the surgeon through the pa- tips are manipulated by the hand grip at
designed for CIS technicians, but can be of value tient’s abdominal wall or chest. The ports the instrument’s opposite end. Electric
to any CRCST technician who works with surgical are tubular sleeves that, after insertion, current only flows through the instru-
instrumentation.
hold the small incisions open. ment when the surgeon activates the
Earn Continuing Education Credits: Both laparoscopic and robotic in- electrocautery control.
Online: You can use these lessons as an in-service struments use several styles of grasping, In contrast, robotic instruments are
with your staff, or visit www.iahcsmm.org for online
grading at a nominal fee.
dissecting, cutting, probing, and electro- like laparoscopic instruments on steroids.
cautery devices, with a variety of oper- The major difference between them and
By mail: For written grading of individual lessons, ating tips that are inserted and removed their laparoscopic counterparts relates
send completed 15-question quiz and $15
to: PEC Business Office, Purdue University, Stew-
through the ports as needed during the to where instrument control originates.
art Center Room 110, 128 Memorial Mall, West surgical procedure. Note: electrocautery is After the ports are placed in the patient,
Lafayette, IN 47907-2034. used to burn and seal blood vessels and to the surgeon leaves the sterile field of the
Scoring: Each 15 question online quiz with a
burn and cut through tissue. All laparo- operating table and takes position at the
passing score of 70% or higher is worth two points scopic and robotic instruments must be robotic console. The surgeon directs the
(2 contact hours) toward your CIS re-certification properly insulated to prevent unintentional assistant to insert each robotic instru-
(6 points) or CRCST re-certification (12 points).
IAHCSMM provides online grading service for
burns to other patient tissue or to members ment into specific ports as needed to
any of the Lesson Plan varieties. Purdue University of the surgical team. perform the procedure. The instruments
provides grading services solely for CRCST and During a laparoscopic procedure, the are then connected to up to five robotic
CIS lessons.
surgeon stands at the operating table arms that function under the surgeon’s
More information: Direct any questions about where he or she can manipulate the direct control.
online grading to IAHCSMM at 312.440.0078. instruments. Visualization is limited The surgeon using robotic instru-
Questions about written grading are answered by
Purdue University at 800.830.0269.
to a two-dimensional view on monitor ments has almost unlimited freedom of

Once The US Food and Drug Administration and grows exponentially with facility size the procedure is completed. adhering to the from laparoscopic and robotic instru- which flows though the instruments only IFU is a major step in helping to ensure mentation. INSTRUMENT INSULATION Electricity is always flowing though tions for Use (IFU) cannot be overstated. Less experienced techni. movement of the instruments’ operating OBJECTIVE 2: REVIEW THE fense to prevent an instrument malfunc- tips and a three-dimensional view of the IMPORTANCE OF FOLLOWING tion that can injure a patient or surgical operative area inside the patient. is critical. soaking an instrument in an Insulation coating is the primary safety robotic arm. The surgeon then their devices. requires surgical instrument manufac. this is not true. AND Laparoscopic and robotic instrumen- manipulate the required instruments and STERILIZING LAPAROSCOPIC AND tation also represents a million dollar tissue during the procedure than is possi. This en. COATINGS the instrument when connected to the For example. couplers However. As a result. the applicable manufacturer’s Instruc. achieved. for your facility. TESTING. Note: similar and electric signals from the console to instruments manufactured by different OBJECTIVE 3: DISCUSS THE manipulate the operating tips. MANUFACTURER INSTRUCTIONS team member. CRITICAL NEED FOR THOROUGH these instruments are very delicate and The importance of strictly adhering to INSPECTION AND TESTING OF can be easily damaged by mishandling. incisions needed to place the ports. ROBOTIC INSTRUMENTATION investment for even the smallest facility ble with laparoscopic instruments. therefore. Doing so is the first line of de. Money spent providing adequate from the robotic arms. on electronic connections. laparoscopic and robotic instruments and these expenditures help to ensure a Robotic instruments are very com. however. companies can also add to confusion. education regarding appropriate re- returns to the sterile field to close the cians may assume that all generations of processing techniques is like insurance. CIS Self-Study Lesson Plan Close-up of damage to insulation on hook dissector. ables him or her to much more accurately FOR CLEANING. made by the same manufacturer should successful laparoscopic/robotic program plex electronic instruments that depend be reprocessed in the same manner. disinfection and sterilization of facility. Multiple studies have reported . electocautery uses enzymatic solution with the incorrect pH device to prevent unintentional burns a much higher level power of electricity can destroy it. and the types and numbers of surgi- ments are removed from the ports (taken turers to provide detailed instructions for cal procedures that are performed at a out of the body cavity) and disconnected cleaning. the instru. the need for a when activated by the surgeon at the that the full life of the instruments can be careful and thorough inspection process robotic console. therefore.

Currently there are testing TEAM MEMBER SAFETY DURING tion can eliminate the need to further test devices available that are designed only LAPAROSCOPIC AND ROBOTIC almost 50% of the remaining instru. Other tactics in. lation should confirm that the insulation dures provided by the manufacturer. of the instruments that were evaluated. Studies The testing process increases the time volve using caution to avoid making inad. the instru.1. inspected. Further procedures may require that processing of these activities on each instrument testing should follow on all instruments personnel remove all jewelry and wear helps ensure a safe surgical procedure for without visual IF. . bility for providing OR personnel with holes in the insulation. have indicated that 5% of laparoscop- required to inspect all laparoscopic and vertent contact with the electrical circuit ic and robotic procedures result in an robotic instruments so identifying the and ensuring that the surrounding area unintentional burn. A properly is free of excess moisture and flammable experience such a burn. Insulation testing device designed for use in Central Service departments. with an implanted pacemaker or other ty of CS staff members is very significant. safety er’s instructions when performing each down the shaft of the instrument. each will require trained team and adequately prepared materials such as CS wrap material. The responsibili- testing in the minimal amount of time. Engineering. rubber or vinyl gloves. One study found IF in 3% of disposable Choosing the insulation test device OBJECTIVE 4: EXPLAIN HOW instruments fresh out of the package. 2 is a decision best made with input from CENTRAL SERVICE PROFESSIONALS These findings are alarming because professionals in CS. electrical device should not operate the without visual indicators of failure in 57% ment should be tagged and immediately testing equipment. Consistent adherence to the manufactur- does not slide back and forth or up and Depending on the manufacturer. thoroughly (CIS) technicians who inspect the insu. always follow prescribed safety proce. Some further surgical intervention with 25% re- inspection station will enable thorough instrument models caution that persons sulting in patient death. the patient and the surgical team. and effectively sterilized. CIS SELF-STUDY LESSON PLAN that insulation failures (IF) were detected When IF are determined. CS laparoscopic and robotic instrumenta- insulation. cracks or the operating room (OR). and slippage of the After a testing system is selected. removed from service. Surgical Services. Certified Instrument Specialist team members should be trained to tion that is properly cleaned. and IMPACT PATIENT AND SURGICAL visual inspection with lighted magnifica.2 Visual indicators of IF include be used in CS and from the sterile field in CIS technicians share a great responsi- missing portions of insulation. for use in CS and other models that can SURGERIES ments. Of the patients who easy (visual) IF save time.

JACK D. following two CSSD professionals who reviewed nessed by any member of the operating tive evaluation. CRCST. 3. (2010). Insulation failure in Maryville. RN. C. ACE. 1. burns and the life-threatening complica. The device sterile. InsulScan. use of IF test equipment in their recom- mended practices for using electrocuatery REFERENCES devices. the visual area is Stiegmann G. and the devices are round. FL opment. and guidelines. manufacturers recommend repair or Patients entrust their lives to their surgi. Zoom out and one sees a wide picture. tion is challenging for CS professionals to . MI please contact Elizabeth Berrios Laparoscopic and robotic instrumenta. and Processing Manager. Werner. Weaver J. and to your struments for IF to prevent unintentional Central Service department peers. LISA HUBER. Espada M. Denver. IN CONCLUSION East Lansing. The Clinical Nurse III Study Lessons. PAULA VANDIVER. Remember that the surgical personnel only visualize. requires a total team effort. Instructions demonstrates an IF. the less visual field Maryville. Zoom in and the picture’s object becomes larger. best way to prevent burns. Ongoing technological advances ADDITIONAL READINGS members from unintentional burns require effort from the CS team to remain 1. Orthopedic Specialist. of each instrument is necessary to assure ing procedures necessary to ensure that 2. and burns almost always CARLA MCDERMOTT. FCS. recommended during laparoscopic or robotic surgery current in reprocessing knowledge. Using IF testing equipment is the instruments are cleaned properly. Standards. CS professionals are vital partners on for use. 4. Inspection must also be proficient in the reprocess. Inc. 2011). Insulation failure in robotic IAHCSMM acknowledges the assistance of the other internal organs may not be wit. Mobile Instrument. 2013. Instead. Healthcare Purchasing News. 205:121. 1992. replacement of any instrument that cal healthcare teams. CRCST. Sterile Burns are not a result of inattention to 2. 2013. Spectrum Surgical. CO. to the operative site. PH. Robinson T. Laparoscopic Insulation Registered Nurses (AORN) includes the and most advanced care that is possible.org). (2002). Am J Obstet Gynecol this lesson plan: team is the key. IL limited by the scope’s distance from the laparoscopic instruments. BA. tional burn to the patient’s intestines or (August. Surg Endosc. (elizabeth@iahcsmm. pg. SERIES WRITER/EDITOR Our Team will provide guidelines and tions that ensue. the distal third of the instrument during a TECHNICAL EDITOR IAHCSMM is seeking volunteers to write procedure. (2010). AORN. to your Association. The length of laparoscopic and robotic instruments ranges from 23cm to 45cm in length. The Association of periOperative this team as they help to deliver the safest 5. CRCST or contribute information for our CIS Self- occur outside their direct vision. Elmed. For more information. Instructions for use. but less surrounding area is visible. at most. the procedure. Montero P. Guarding against an safety. Endo-test. CS Technician. et al. CIS. Anderson Hospital. Munoz R. Doing so is a great way to patient and the team members depend South Florida Baptist Hospital contribute to your own professional devel- on the thorough inspection of the in. NINEMEIER. June issue. IL is available for viewing. Every millimeter of their length must be CIS SELF-STUDY inspected every time the instruments are LESSON PLANS reprocessed. CIS Self-Study Lesson Plan Protecting patients and surgical team manage. and laparoscopic instrumentation: a prospec. Understanding that an uninten. Instructions for Use Manual. are unseen killer: stray electrosurgical burns.D. This effect is just like that of a camera with a zoom lens.e1-5. Tester. AORN. operative site: the closer the scope’s tip is 24(2):462-465. Anderson Hospital. help you with the lesson to assure it will be Michigan State University an enjoyable process. They practices. and are functioning as designed. Noble BN. Plant City.28.

Those completed with both laparoscopic used during the inspection process and robotic instruments c. Laparoscopic instruments b. Those completed with laparoscopic a. Which procedures require the surgeon 7. Who requires surgical instrument is sent to the operating room c. Robotic instruments c.iahcsmm. Those completed with robotic unintentional burns from laparoscopic insulation should not be operated by instruments and robotic instrumentation? persons with an implanted pacemaker. The instrument should be carefully occur when there are burns from instructions for cleaning. False 2. Some equipment used for testing laparo- to stand at the operating table? processing procedure to prevent scopic and robotic instrumentation a. the greater the amount d. 7 percent surgeon a three-dimensional view of the scopic and robotic instrumentation? d. All the above of visual field that will be available for 4. True a. The instrument’s on/off switch a. Electrocautery is a surgical process used to: 6. The defect should be noted when it surgical personnel 5. Burn and seal blood vessels robotic instruments made by the same detect insulation failures are only b. U. When special tips are placed on b. No further testing of instruments is a. b. The Joint Commission c. 3 percent 8. A and B above a. Devices that test electrical currents b. The instrument should be tagged and c. All testing devices currently available to a. When it is connected to the robotic arm required if visual inspection indicates b. IN 47907-2034 Email Address 800. Cracks or holes in the insulation 14.org) REQUEST FOR PAPER/PENCIL SCORING (please print or type information below) ❍ I have enclosed the scoring fee of $15. All of the above statements are true a. True instruments b. d. inspected during the next processing laparoscopic and robotic instrumentation and sterilizing their devices? cycle to determine if the problem d. 5 percent 3. All generations of laparoscopic and 11. robotic instrument? 9. Life-threatening complications can manufacturers to provide detailed b. What should be done if insulation failures during a procedure the specific instrument are noted during inspection? b.0269 If your name has changed in the last 12 months. Missing portions of insulation a. Which type of instrument offers the inspection of the insulation on laparo.830. Proper cleaning of the instruments’ laparoscopic and robotic procedures procedures require the surgeon to operating tips results in an unintentional burn? stand at the operating table a. Surgical personnel only visualize the the instrument distal one-third of an instrument d. AND RETURN TO: City State/Province Zip Code/Postal Code Purdue University PEC Business Office (_______________________________________________________________________________ ) Stewart Center. Sponsored by: CIS Self-Study Lesson Plan Quiz - Laparoscopic and Robotic Surgical Instruments . Only when the electrocautery pedal there is no insulation failure.ESSONEXPIRES-AY 1. False b. Which statement is true? c. is activated. Neither laparoscopic or robotic d. Food and Drug Administration be immediately removed from service d. The device’s insulation coating 13. Slippage of the insulation operative site. operations. Centers for Disease Control & Prevention d. We regret that no refunds can Name be given) ❍ Check here if you have a change of address _______________________________________________________________________________ Mailing Address (be sure to include apartment numbers or post office boxes) ❍ Check here if you wish to have your results emailed to you _______________________________________________________________________________ DETACH QUIZ. False a. Burn and seal the cut ends of the bowel the same manner. Burn and cut through tissue manufacturer should reprocessed in designed for use in Central Service c. Which can be noted by careful visual b. When is electricity flowing through a viewing by the surgeon. False c. disinfecting. True a. a. Burns almost occur outside vision of a. The closer a scope’s tip is to the b. True 15. Room 110 Daytime telephone IAHCSMM Membership Number 128 Memorial Mall _______________________________________________________________________________ West Lafayette.ESSON. please provide your former name Purdue University is an equal access/equal opportunity institution . Any of the above depending on the facility’s policy REQUEST FOR ONLINE SCORING (payment and scoring made directly online at www. (please make checks _______________________________________________________________________________ payable to Purdue University. 9 percent operative area? a. True e. False b.S. FOLD. All the above b. c. At any point above depending upon 10. Approximately what percentage of d. AAMI has worsened b. What is the primary safety device or 12.O#)3)NSTRUMENT#ONTINUING%DUCATION )#% s.