concorde career college, department of surgical technology st210

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Biomedical Sciences: Information Technology, Electricity Concepts, Robotics, & The Future of Surgery

Concorde Career College, Department of Surgical TechnologyST210

Information Technology

Objectives

Define the term computer

List and describe the basic components of a computer system

Understand basic word processing and the use of graphics

Objectives

Access the internet to gather information

Apply basic computer skills to the educational process and to surgical case management

Demonstrate knowledge of terminology related to computer skills verbally and in the written form

Utilization of Computer Technology in the Operating Room

Scheduling Send/Receive Orders Send/Receive Medical

Records Update Pt. Chart Insurance Billing Update Surgeon’s

Preference Card Manage and Print

Instrument Count Sheets Order Supplies Complete Operative

Record Laboratory Requisitions

Utilization of Computer Technology in the Operating Room

Surgical patient scheduling software

Utilization of Computer Technology in the Operating Room

Preference Card Applications

As opposed to…

Utilization of Computer Technology in the Operating Room

…Hand written Often illegible Difficult to find Easily lost Can be taken with

the surgeon to another facility

Utilization of Computer Technology in the Central Sterile Department

Order Supplies and Instruments

Maintain Inventory Par Levels

Save and Manage Sterilization Records

Create Instrument Tray Menu Cards

Interdepartmental Equipment Transfers

Track Equipment Maintenance

Utilization of Computer Technology in the Operating Room

Supply chain maintenance and ordering software

Robotics

The use of robotics in the OR is gaining in popularity among many surgical specialties

Integrates complex computer science and mechanics

STs are often required to maintain, manage, sterilize, and manipulate this equipment

Must understand basic computer concepts in order to successfully function in the robotics-integrated OR suite

Internet Basics

Global network connected through millions of servers

World Wide Web (www) is the most recent format for the Internet

Photo and Article Access Each has address begins http://www. Not all Web addresses contain www Ending of address identifies what type

organization publishes the information (.org, .gov, .edu, etc.)

Internet Basics

Research for Homework and Projects Avoid using sites like Wikipedia that are not

peer reviewed, professional data sources Prefer scholastic search engines to general

search engines▪ Google Scholar: http://scholar.google.com/▪ iSeek: http://education.iseek.com/iseek/home.page▪ Library of Congress: http://www.loc.gov/index.html▪ Google Books: http://books.google.com/▪ Science.gov: http://www.science.gov/

Electricity Concepts

Objectives

List and describe the basic components of an electrical receptacle.

Analyze the relationship between magnetism and electricity.

Identify basic electrical equipment utilized in the surgical environment.

24

Electricity – Uses in the OR

Electrosurgery X-ray Endoscopes Lasers Robotics

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Atoms, Electrons, and Matter

Matter is anything that has mass and occupies space

All matter consists of atoms

Volume is the amount of space occupied by an object.

Protons – Inside nucleus and positively charged

Neutrons – Inside nucleus; neutral particles

Electrons – Revolve around the nucleus; negatively charged particles

Atoms are composed of small particles: Protons Neutrons Electrons

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Electron Theory

Electrons revolve around the nucleus in paths called shells or orbits

Electrons that are located closer to the nucleus demonstrate a stronger attraction the nucleus; electrons moving in the outer orbits are less attracted.

In certain atoms, if these outer electrons are exposed to light, heat, or electric energy, they will speed up and leave the atom

27

Electricity

These outer electrons are known as free electrons

The movement of free electrons creates electric current

The term electricity describes the free electrons moving or flowing from the ring of one atom to another

28

Conductors

Materials that allow the flow of free electrons

Examples: silver, iron, saltwater, copper

Copper is the commonly used because it’s the most economical

Examples of OR devices that use copper: OR lights, power drills, ESU

29

Conductors

Because water is a conductor of electricity, the amount of humidity in the air is important

High humidity often results in static charge leakage

Low humidity results in the formation of sparks

Humidity in the OR is maintained between 50% and 55%

30

Insulators

Materials that inhibit the flow of free electrons

Insulators are simply poor conductors

Conductors are wrapped in insulation to prevent leakage of electrons while the current flows to the device that will use it.

Examples of insulators in the OR are the plastic and rubber casings that cover the ESU cords

Electrical Charge

Can be either negative or positive. Like charges repel each other, unlike

charges attract each other. 2 negative charges or 2 positive charges

will repel each other.▪ ***Opposites attract***▪ (magnets)

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Electrical Current

Electric current is movement of the electrical charge

The electrical current travels through conductors by movement of the free electrons that migrate from atom to atom inside the conductor

35

Power, Load , and Switch

Power – the rate at which work is done (ex- battery) Power is measured in watts (W)

Load – the device that uses the energy (ex- flashlight bulb)

Switch – device that opens or closes a circuit and controls the flow of electricity (ex- between the battery and flashlight)

Wall Outlets

Plugs used in surgery have 3 prongs. Components: ▪ First prong (positive)▪ Second prong (negative)▪ Third prong (ground)

If electrical short occurs, the electrical current will flow through the grounded plug to reduce the risk of current passing through surgical team or patient. Must never be removed to fit in a 2 prong plug.

37

Direct and Alternating Current

Direct (DC): electrical current that flows in one direction. Batteries

Alternating (AC): electrical current that reverses direction periodically. A complete cycle moves in one direction and then reverses its course. Electrosurgery

38

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Electrosurgical Unit (ESU) Circuit Generator (power source) Active electrode (electrosurgical pencil)

Delivers the electric current to the surgical site through the tissue, the energy is converted from electrical to thermal.

Patient Dispersive electrode/inactive electrode

(grounding pad) Electric current is channeled back to the

generator via the grounding pad Placing the grounding pad p 112

40

Monopolar/Bipolar

Monopolar Most common Coagulation or

cutting, or blend Large areas Grounding pad

needed

Bipolar Less frequent Only coagulation Delicate procedures Areas of moisture Grounding pad not

needed

41

Accessories to Electrosurgery

Harmonic scalpel Ultrasonic energy Cut and coagulate Surrounding tissue suffers less thermal

damage (charring) A grounding pad is not necessary ▪ No electricity

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Advantages of Electrosurgery

Reduced blood loss Saves time Cutting current also burns tissue

reducing the need to stop and control bleeding

Cutting current seals small spaces in the tissue and lymphatic vessels

43

Dangers of ESU

Electrical burns Patient and surgical team▪ Resonant frequency (RF) capacitive coupling:

AC travels from active electrode, across insulation and into skin.▪ EX: surgeon clamps hemostat to bleeding vessel

▪ Dielectric Breakdown: occurs when high voltage breaks down insulating material (gloves) causing a hole and possibly burning the individual.

44

Laser Light

Different from ordinary light Monochromatic Coherent Collimated Its color will decide how it will react

with various tissues Red laser light is absorbed by red-

pigmented tissue Photon: a particle of LASER light

energy

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Laser

Fluence Spot size, watts, time

Four interactions of laser with tissue Absorption, transmission. reflection, or

scattering

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Parts of a Laser System

Energy pump (excitation source) responsible for delivering the energy to the laser head to produce laser light - can be from any energy form (media)

Laser head – active medium that produces the laser energy. Lasers are named according to active medium. Mirrors are positioned at both ends of laser head. Laser energy is reflected off mirrors.

Ancillary components – includes the console, cooling system and vacuum pump

Control panel – controls for operating the system; includes wattage, duration, and mode

Delivery system – transports the laser energy from the laser head to the tissue. Ex – articulated arm, fiber, fixed optical array

47

Lasers Carbon Dioxide Argon Nd:YAG Holmium: YAG **YAG=pulsed beam

CO2

Most frequently used Invisible beam

Helium-neon laser beam is transmitted with the Co2 laser to aid in aiming (red color)

Permits precise cutting and coagulating Absorbed by cellular water content (not

dependent on tissue color or consistency) Not effective for use where the laser light needs

to be transmitted through clear fluids. Delivered through an articulated arm w/ mirrors

positioned at the articulations.

48

Argon

Produces a blue or green light Plasma tube that contains argon

$$$ Laser energy is converted to heat

when absorbed, produces coagulation and vaporization.

Can travel through clear fluids and tissues, absorbed in tissue by hemoglobin or melanin.

Used in treatment for the eye 50

Nd: YAG

Consists of crystal laced with neodymium.

Invisible beam: requires helium-neon laser aiming beam

Absorbed by darker tissue Can be transmitted through clear

fluids. Used to vaporize bladder tumors Delivered through non contact or

contract fiber delivery system. 52

Robotics

58

Robotic Surgery

Objectives

Define the term robot.

Provide a timeline of the events leading up to the use of robots in the surgical environment.

List the advantages and disadvantages to the use of robots in the surgical environment.

Objectives

Describe the principles of geometry that relate to robotics.

Identify the basic components of the surgical robot and describe the function of each.

Objectives

Describe the mechanisms by which the surgical robot operates.

Apply knowledge of robotics to safe practice in the surgical environment.

Demonstrate knowledge of terminology related to robotics verbally and in the written form.

Definition

A robot is a machine designed to operate in a seemingly human way, with speed and precision. There are as many different types of robots as there are tasks for them to perform.

Definition

Robotics is a branch of engineering that involves the conception, design, manufacture, and operation of robots. This field overlaps with electronics, computer science, artificial intelligence, mechatronics, nanotechnology, and bioengineering.

64

Why Robotic Surgery?

Improve surgical patient care Overcome human limitations Reliable Complex

History

First generation robots are simple machines capable of performing precise repetitive motions at high speeds.

History

First Generation Robot

No artificial intelligence (AI)

Require constant oversight

History

Second generation robots incorporate a level of artificial intelligence.

History

Second Generation Robot

Requires occasional monitoring

AI (computer chip) Tactile sensors Auditory

capabilities Visual abilities

History

Third generation robots are autonomous.

History

Third generation robot

Mars Rover Spirit

Works independently (without supervision)

Controlled by a central computer

History

Fourth generation robots are not yet developed.

History

Fourth generation robot

Predicted to have ability to:

Learn Reproduce Evolve

Robotics

Delta (Berlin, Germany) Robotic

Surgical Microscope

Advantages Vs. Disadvantages

Advantages Decreased hospital stay/reduced

overall cost Reduced tremor Expert surgeon available even if not

in geographic area Reduced risk of transfer of disease

Disadvantages Initial cost of equipment is great Actual operating time may be

increased especially during learning curve

Technical difficulties

Geometry

Study of figures in a space of a given number of dimensions and of a given type.

Cartesian Geometry

René Descartes (1637) introduced the use of coordinates for describing plane curves, the axes were omitted, and only positive values of the x- and the y-coordinates were considered, since they were defined as distances between points. For an ellipse this meant that, instead of the full picture which we would plot nowadays, Descartes drew only the upper half.

Geometrical Terms

Point Ray or plane X axis or plane (horizontal) Y axis or plane (vertical) Origin (intersection) Angle Z axis or plane (third dimension) Slope Curvilinear

Robotic Components

Five Basic Components of the Surgical Robot

Controller (Hermes) Arm (AESOP – voice controlled) Drive (Zeus – Motor) End Effector (Instruments) Sensor (AI)

Socrates – Telecommunication system

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Robotic Arm

End Effector

81

DA VINCI ROBOT SYSTEM

DA VINCI ROBOT SYSTEM

82

Coming Technologies

NOTES Anesthesia Robots

NOTES

Natural Orifice Transluminal Endoscopic Surgery

NOTES

Anesthesia Robots

Closed-loop anesthesia systems McSleepy

Fully Robotic Surgery

McSleepy meets DaVinci

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What are your responsibilities?

Surgical technologists will be responsible for: Setting up the robot Running the computer

programs Operating equipment

during the surgical procedure

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