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FLS Module 1 Questions and Answers 2025, Exams of Advanced Education

Illinois State University (ISU)Advanced Education

FLS Module 1 Questions and Answers 2025

Typology: Exams

2024/2025

Available from 07/07/2025

johniewalker91
johniewalker91 🇺🇸

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FLS Module 1
What are available laparoscope diameters? - answer2-10mm
What degree scope is best for a field of view in-line with a port? - answer Zero degree
What is the most commonly used light source? - answer300 W Xenon lamp
What if there is initial low pressure and high flow rate at entry? - answer There may be a
leak in the insufflator circuit. Check all connections.
Benefits of Monopolar energy. - answer Tissue heated quickly. Less thermal
spread/coagulation.
Monopolar voltage/frequency – answer Low voltage, High frequency
What does coagulation mode do? - answer Rapid surface heating with shallow depth of
necrosis. intermittent wave form with higher voltage.
What are some risks of monopolar energy? - answer Current can be diverted through
unintentional pathways leading to inadvertent tissue injury. To avoid this, do not use
"hybrid" ports that mix plastic with metal.
How does a grounding pad avoid injury with monopolar energy? - answerGrounding
pads help avoid capacitative coupling. This happens when two conductors are
separated by an insulator and the passive electrode stores energy that can be released
with tissue injury. The grounding pad inhibits the passive electrode from storing energy.
Benefits of bipolar energy. - answer- Lower risk of inadvertent injury.
- Produces less thermal spread and necrosis.
- No grounding pad necessary.
- Works in a "wet" operative field.
Risks of bipolar energy. - answerMay cut patent blood vessels before adequate sealing.
Device will not work if there is metal between the jaws.
Risk of ultrasonic dissection (harmonic). - answerThe active blade can inadvertently
injure something due to high frequency (50mHz).
Does aspirin need to be discontinued day of surgery. - answerNo
How to best enter a patient with bowel obstruction. - answerDirect visualization.
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FLS Module 1

What are available laparoscope diameters? - answer2-10mm What degree scope is best for a field of view in-line with a port? - answer Zero degree What is the most commonly used light source? - answer300 W Xenon lamp What if there is initial low pressure and high flow rate at entry? - answer There may be a leak in the insufflator circuit. Check all connections. Benefits of Monopolar energy. - answer Tissue heated quickly. Less thermal spread/coagulation. Monopolar voltage/frequency – answer Low voltage, High frequency What does coagulation mode do? - answer Rapid surface heating with shallow depth of necrosis. intermittent wave form with higher voltage. What are some risks of monopolar energy? - answer Current can be diverted through unintentional pathways leading to inadvertent tissue injury. To avoid this, do not use "hybrid" ports that mix plastic with metal. How does a grounding pad avoid injury with monopolar energy? - answerGrounding pads help avoid capacitative coupling. This happens when two conductors are separated by an insulator and the passive electrode stores energy that can be released with tissue injury. The grounding pad inhibits the passive electrode from storing energy. Benefits of bipolar energy. - answer- Lower risk of inadvertent injury.

  • Produces less thermal spread and necrosis.
  • No grounding pad necessary.
  • Works in a "wet" operative field. Risks of bipolar energy. - answerMay cut patent blood vessels before adequate sealing. Device will not work if there is metal between the jaws. Risk of ultrasonic dissection (harmonic). - answerThe active blade can inadvertently injure something due to high frequency (50mHz). Does aspirin need to be discontinued day of surgery. - answerNo How to best enter a patient with bowel obstruction. - answerDirect visualization.

Cut vs Coag - answerCut: Heats tissue quickly to convert cell water to steam, lysing the cell. Coag - Heat more widely dispersed, less cutting. Benefits of "Cut mode" - answer- Low voltage

  • High frequency
  • Continuous waveform
  • Heats tissue quickly. Cell water converts to steam and causes the cell to lyse/explode. Benefits of "Coagulation mode" - answer- High voltage
  • Low frequency
  • Intermittent waveform
  • Rapid tissue heating, shallow depth of necrosis.
  • Non-contact. Relies on sparking to tissue. What is direct coupling? - answerWhen a monopolar instrument is in direct contact with another metal instrument and energy is transferred. What are other dangers of energy use besides direct and capacitative coupling? - answer- Current diversion
  • Narrow return circuit. Bipolar seals vessels up to _____ mm in diameter. - answer7mm Ultrasonic coagulation shears seal vessels up to _____mm in diameter. - answer5mm Benefits of Ultrasonic Coagulation shears. - answer- Combo compression and friction.
  • One active blade.
  • Monopolar capabilities with the active blade.
  • No capacitative coupling.
  • High power (Max): Cut
  • Low power (Min): Coagulation How many days prior to surgery should Warfarin be discontinued? - answer3 days ASA 1 Classification - answerHealthy adult ASA 2 Classification - answerMild to moderate systemic disease ASA 3 Classification - answerSevere systemic disease that limits patient activity. May or may not be related to reason for surgery. ASA 4 Classification - answerSevere systemic disease that limits patient and are life- threatening with or without surgery.

Chemical effects of CO2 - answer- Increase arterial and end tidal CO2.

  • Decrease serum pH w/greatest change in first 20 minutes. Steady state in 1 hour. Pressure effects of CO2. - answerPulm:
  • Reduced functional residual capacity
  • Reduced pulmonary compliance
  • Increased peak airway pressure CV
  • Increased preload and after load. (Decreases Cardiac Output)
  • Bradycardia
  • Pre-ventricular Contraction
  • Increased Vena Cava resistance and decreased venous flow --> Increased risk of VTE. Renal
  • Intra-operative oliguria d/t increased intra-abdominal pressure --> Decreased renal blood flow. Shortly after insufflation pt. becomes hypotensive, bradycardic w/decreased urine output. What do you do? - answerYou are experiencing vagally-induced bradycardia.
  • STOP, desufflate immediately.
  • Check adequate relaxation.
  • Check intravascular volume status.
  • Check for other causes of hypovolemia (i.e., bleeding)
  • Once stable and other causes have been r/o may re-insufflate. Pt suddenly becomes hypotensive, tachycardic, and you note JV distention with an audible mill-wheel murmur on CV exam. What do you do? - answerYou are experiencing CV collapse from an Air/Gas embolism.
  • Place patient in trendelenburg, left side down.
  • Rapid IVF resuscitation
  • Central line placement to back up embolus in right heart chambers. How to perform laparoscopic small bowel examination for SBO. - answerPlace ports along the left abdomen. In an SBO start at the ileocecal valve. This is the most decompressed section in an SBO. FNA uses ____ gauge needles. - answer20-22ga Core biopsy uses a ____ gauge needle. - answer14-16ga Laparoscopic intracorporeal suturing technique. - answer- Ports should be at least 10mm apart to allow movement of instruments.
  • 10 to 12mm trocars accomodate standard SH needle. What is the length of suture for intracorporeal knot tying? - answer6in (15cm)

Length of suture for extracorporeal knot tying? - answer30in (76cm) The 2-2.5mm staples are _____ color and used for ______. - answer1. Whit/Grey

  1. Vascular, thin tissue The 3-3.5mm staples are ____ color and used for _____. - answer1. Blue
  2. Majority of GI tract Downside of monopolar energy. - answer- Used on small vessels with slow rate bleed.
  • Must be a relatively dry field. Days until general diet tolerated.
  1. Fundoplication
  2. Colon resection - answer1. Fundoplication 1-2 days.
  3. Colon resection 3-6 days. Post-op small vessel vascular injury is typically... - answerSuperior/inferior epigastric vessels, mesenteric arteries/veins --> abdominal wall/peritoneal hematomas. Require surgery if hemodynamic instability, continued bleeding or infection. In the event of a blank screen, which is NOT a likely problem site? - answerFRED anti- fog solution When using the ultrasonic shears, the entire portion of the active blade is exposed. In order to avoid inadvertent delivery of energy to tissue in contact with the bottom portion of the active blade, one should... - answerGrab the target tissue and elevate it, and keep the active blade upwards in the view of the surgeon. Initial consultation for laparoscopic surgery must include what? - answerDiscussion regarding the possible conversion to open laparotomy. True or false, bowel obstruction is a contraindication to laparoscopic surgery. - answerFalse True or false: Diagnostic laparoscopy may be performed using local anesthesia alone, or mild sedation. - answerTrue True or false: General anesthesia typically results in less hemodynamic changes than local anesthesia. - answerFalse When checking proper placement of Veress needle, which of the following is the most accurate method to detect proper intraperitoneal placement? - answerInsufflator display revealing flow of CO2 and low initial pressure. Umbilical Veress needle insertion and blind trocar insertion is contraindicated in all the following except.

Inert gas (Argon, Helium) benefits as insufflation gas compared to CO2. - answerNo hypercarbia or acidosis. Inert gas (Argon, Helium) risks as insufflation gas compared to CO2. - answer- Less soluble in blood --> Increased risk of gas embolism and extraperitoneal extravasation.

  • More expensive.
  • Insufflator devices are not readily available. Cardiovascular changes with pneumoperitoneum. - answer- Increased preload and afterload.
  • Decreased cardiac output --> Hypotension, cardiac arrhythmia, decreased urine output, increased end-tidal CO Cardiac arrhythmias due to pneumoperitoneum. - answer- Sinus tachycardia.
  • Premature ventricular contractions.
  • Bradycardia By what percentage do venous flow rates drop during pneumoperitoneum? - answer26- 39% What is the incidence of VTE following laparoscopic cholecystectomy? - answer0.5% Renal effects of pneumoperitoneum. - answer- Intraoperative oliguria (Increased pressure --> decreased blood flow --> decreased filtration and urine output). Secondary release of renin and ADH --> Na and free water reabsorption. *** Typically resolves within a couple of hours. Strategies to avoid hypothermia. - answer- Warmed IV fluids.
  • Forced air body warmer.
  • Warm OR room temperature.
  • Warm irrigation fluid. What is the incidence of air/gas embolus during laparoscopic surgery? - answer<1% Gas embolus diagnosis. - answer- Severe hypotension
  • JVD
  • Tachycardia
  • Mill wheel murmur (Characteristic) Gas embolus treatment. - answer- STOP insufflation.
  • Evacuate pneumoperitoneum
  • Place pt in trendelemburg with left lateral side down.
  • Rapid fluid administration.
  • Central line placement into right atrium to evacuate or break up embolus in right heart chambers.

What is the most common dysrhythmia during pneumo insufflation? - answerBradycardia (Vagally mediated) The development of hypercarbia is influenced by... - answer1. The body's buffer system.

  1. Pulmonary system
  2. Extraperitoneal insufflation True or false: Bradycardia is a sign of air/gas embolism? - answerFalse: Correct signs are hypotension, tachycardia, mill-wheel-murmur and JVD. What are the most common sources of unrecognized bleeding? - answer- Trocar injury of abdominal wall vessel.
  • Injury to organs away from operative field.
  • Tamponade of venous bleeding by the pressure of pneumoperitoneum (Drop gas pressure to 8 while deflating.) In the pediatric population, port size greater than ______mm require fascial closure? - answer5mm Abdominal wall closure of port sites can be accomplished by... - answer1. Open techniques
  1. Laparoscopic assisted techniques.
  2. Entirely laparoscopic techniques. What is the correct patient position for diagnostic laparoscopy for appendectomy. - answer- Trendelenburg True or False: Crohn's disease can be diagnosed laparoscopically. - answerTrue What area of the abdomen is best for placement of ports to view the kidneys and adrenal glands? - answerUpper abdomen (Epigastric, RUQ, LUQ) In general, if an ovarian cyst is larger than 5cm or has complex internal US findings, biopsy should be done by _________. - answerOophorectomy Intracorporeal knot tying. - answer- The ideal suture length is roughly 6in.
  • Ideal orientation of suturing is from 3 to 9 o'clock. Pulling the suture along its arc through the tissue. For how many days postoperatively swill shoulder pain secondary to diaphragmatic irritation typically persist? - answer1-3 days. What classes of medication are typically used for post-anesthesia nausea and vomiting? - answer- Antihistamine
  • Serotonin receptor antagonist.

Which position is best for diagnostic laparoscopy of retroperitoneal structures ABOVE the bifurcation of the aorta. - answerLateral position. Which position is best for diagnostic laparoscopy of retroperitoneal structures BELOW the bifurcation of the aorta. - answerTrendelenburg with or without lithotomy. What is the best location of port placement to view the kidneys and adrenal glands? - answerAlong the costal margin. Different biopsy methods used in laparoscopic surgery. - answer1. Peritoneal washings and scrapings.

  1. FNA
  2. Core needle biopsy
  3. Incisional (wedge) biopsy.
  4. Excisional biopsy. FNA setup - answer- 20-22ga Needle.
  • Need sufficient needle length.
  • Plunger with finger loops is helpful. Core needle biopsy setup. - answer- 14 to 18ga needle.
  • Most commonly used for biopsy of the liver.
  • More at risk of bleeding. Biopsy forceps. - answerJaws have a cutting rim and are hollowed out in the center to capture and prevent crushing the tissue sample. Wedge biopsy. - answerUse a scissor, scalpel or stapling device. Peritoneal washing. - answerShould be obtained early in staging laparoscopy. Infuse at least 100cc of .9% NS solution (unless abundant ascites is present). *** +/- mixed sample with a heparin solution for proper cytologic examination. Incisional vs excisional biopsies. - answerIncisional is taking a small piece of a large pathology. Excisional is removing the pathology and sending to pathology. Lymph node biopsy. - answerExcisional biopsy. Small nodes can be removed through a 10-12mm port. If larger, must use a specimen bag.