Key Takeaways: Updates to the Guideline for Minimally Invasive Surgery Focus on Safety
By: Periop Today
Published: 5/10/2023
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Guideline for Minimally Invasive Surgery: Critical Updates Every Periop Nurse Needs to Know
Minimally Invasive Surgery (MIS) offers patients several advantages over open procedures – when appropriate. But there are risks for injury or complications related to the use of MIS technology and associated devices and supplies.
That’s why it is critical that perioperative nurses ensure they are current on the latest updates to this guideline.
Safe Environment
Key Takeaway
The perioperative team should assess and monitor the patient for risks, complications, and injuries related to MIS.
Explanation
New: Preoperative assessment of risk factors associated with MIS complications facilitates safe patient care. 1.4
New: Signs of a gas embolism vary depending on whether the embolism is venous or arterial, may be nonspecific, and can precipitate a life-threatening emergency. 2.4.1
New: Assessing the patient intraoperatively for injuries and complications associated with computer-assisted navigation and robotic-assisted surgical procedures facilitates prevention and detection of patient harm. 4.1
Key Takeaway
The perioperative team should be prepared for conversion to an open procedure.
Explanation
New: Discussing the potential for conversion to an open procedure during the preoperative briefing will allow the team to identify and gather resources in advance and better anticipate potential intraoperative changes to the preoperative plan.
Irrigation & Fluid Distention Media
Key Takeaway
NEW The perioperative team may collaborate to determine patient-specific maximum hysteroscopic fluid deficit thresholds.
Explanation
The American Association of Gynecologic Laparoscopists, the British Society for Gynaecological Endoscopy, and the French College of Gynaecologists and Obstetricians have each developed recommendations for maximum fluid deficits based on expert opinion.
Tolerance for fluid absorption and decisions regarding the continuation or termination of a procedure depend on the patient’s size, age, comorbidities, and level of health. 3.3.2
Communication
Key Takeaway
New: The perioperative team should develop effective communication and workflow processes for robotic-assisted procedures.
Explanation
Moderate-quality evidence identifies an increased risk for impaired team communication and disruption to surgical workflow during robotic-assisted surgery, particularly when the surgeon is working at the console and physically distanced from the patient and the rest of the perioperative team. 4.3
Robotics
Key Takeaway
New: Docking of robotic equipment should be performed by two competent perioperative team members.
Explanation
Having a non-scrubbed person move the robotic equipment and a scrubbed person guide the robotic equipment as it is moved over the sterile field protects the patient from a collision with the robotic equipment and prevents contamination of the sterile field. 4.4.3
Key Takeaway
New: The perioperative team should be prepared to manage a robotic emergency.
Explanation
Considerations associated with emergencies during robotic-assisted procedures add to the complexity of planning their management, including procedures for emergent undocking and manually opening robotic instrument jaws when functionality of an instrument arm is lost. 4.5
Magnetic Resonance Imaging
Key Takeaway
New: An interdisciplinary team led by a magnetic resonance (MR) director should develop a perioperative MR safety plan.
Explanation
The perioperative MR environment integrates the perioperative OR with the MR scanner and has unique safety considerations that set it apart from the traditional radiology setting. Establishing a perioperative MR safety plan provides the foundation for safe MR practices that are tailored to the perioperative setting. 6.1
Interdisciplinary collaboration between individuals from the perioperative and MR environments uses their respective expertise. 6.1.1
An MR safety plan that includes provisions for safe staffing, plans for policy and procedure development and review, management and labeling of equipment used in the MR hybrid OR, description of strategies or indicating magnetic field strength in the MR hybrid OR, consistent practices, procedures for reporting and reviewing adverse events, education of personnel, and continuous quality improvement will mitigate risks associated with unsafe practices in the MR environment.
Key Takeaway
The MR director, MR safety officer, MR safety expert, and perioperative RN leaders should implement measures to mitigate the risk for injury in the presence of the MR scanner.
Explanation
New: It is safe for personnel who are pregnant to work in the MR environment but they should not remain within zone IV (i.e., near the scanner) during image acquisition. The MR environment does not present a risk of exposure to ionizing radiation. 6.7
Key Takeaway
New: The perioperative team should perform an MR safety time out before beginning the procedure.
Explanation
The purpose of the time out is to confirm that MR safety screening has been completed for all individuals who are in the MR hybrid OR and to verify that MR safety precautions have been taken. 6.10
The elements of the MR safety time out will vary by facility depending on the type of MR scanner present, the configuration of the hybrid OR, the procedures performed, and the workflow processes of the perioperative team. 6.10.2
Review the full AORN Guideline for Minimally Invasive Surgery
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