Docsity
Log inSign up
Docsity
Prepare for your exams
Prepare for your exams

Study with the several resources on Docsity

Earn points to download
Earn points to download

Earn points by helping other students or get them with a premium plan

Guidelines and tips
Guidelines and tips
Sell on Docsity
Sell on Docsity
Log inSign up

Prepare for your exams

Study with the several resources on Docsity

Find documents

Prepare for your exams with the study notes shared by other students like you on Docsity

Search Store documents

The best documents sold by students who completed their studies

Search through all study resources
Docsity AINEW

Summarize your documents, ask them questions, convert them into quizzes and concept maps

Explore questions

Clear up your doubts by reading the answers to questions asked by your fellow students

Earn points to download

Earn points by helping other students or get them with a premium plan

Share documents
download point icon20 Points

For each uploaded document

Answer questions
download point icon5 Points

For each given answer (max 1 per day)

All the ways to get free points
Get points immediately

Choose a premium plan with all the points you need

Study Opportunities

Choose your next study program

Get in touch with the best universities in the world. Search through thousands of universities and official partners

Community

Ask the community

Ask the community for help and clear up your study doubts

University Rankings

Discover the best universities in your country according to Docsity users

Free resources

Our save-the-student-ebooks!

Download our free guides on studying techniques, anxiety management strategies, and thesis advice from Docsity tutors

From our blog

Exams and Study
Go to the blog

FLS Module 3 - basic laparoscopic procedures Questions and Answers Fully Solved, Exams of Advanced Education

Illinois State University (ISU)Advanced Education

FLS Module 3 - basic laparoscopic procedures Questions and Answers Fully Solved

Typology: Exams

2024/2025

Available from 07/07/2025

johniewalker91
johniewalker91 🇺🇸

635 documents

1 / 8

Toggle sidebar

This page cannot be seen from the preview

Don't miss anything!

bg1
FLS Module 3 - basic laparoscopic
procedures
What are some of the newest developments in laparoscopic surgery? - answer Robotic
assistance, single port site procedures, Natural Orifice Translumenal Endoscopic
Surgery (NOTES), and intrauterine fetal surgery
List 5 laparoscopic procedures that are performed on newborn infants - answer
appendectomy, undescended testes, anti-reflux surgery, pectus repair, PDA, intestinal
atresia, pyloromyotomy, and surgery for Hirschsprung's disease
Indications for diagnostic laparoscopy - answer elective - cancer staging, chronic
abdominal pain
urgent - small bowel obstruction, vs ileus
Emergent - trauma, suspected iatrogenic injury, perforated viscous
During what procedures could you inadvertently enter the peritoneal cavity and
subsquently need to perform a diagnostic laparoscopy? - answer hysteroscopy,
endoscopy
Key elements of performing a lysis of adhesions - answer Use both blunt and sharp
dissection with gentle traction on tissue. Be cautious and sparingly use energy sources
for hemostasis to avoid thermal spread
What is the best position for patients getting surgery on the upper abdomen? -
answerArms on arm boards, reverse trendelenburg position with a footboard and safety
strap on lower thighs to keep patient from sliding. Monitors placed at head of table for
viewing operative field.
What is the key to patient positioning? Where would you place your initial port for a
diagnostic lap where you need to view the entire abdomen? After your initial port, where
do you place additional ones? - answerMaximize the ergonomics of the surgeon and
assistant. Usually initiate access in LUQ and 2 additional ports can also be placed in the
left abdomen (then surgeon and assistant can stand on left side together). This allows
the entire abdomen to be visualized except for immediately below the ports or lateral to
the ports.
General principles of diagnostic lap of the liver - answerAngled scope
Tools for biospy and hemostasis
May need ultrasound to visualize structures under the surface.
To see anteriorly: may need adhesiolysis
To see posteriorly: may need special liver retractor or careful use of blunt instruments
pf3
pf4
pf5
pf8

Partial preview of the text

Download FLS Module 3 - basic laparoscopic procedures Questions and Answers Fully Solved and more Exams Advanced Education in PDF only on Docsity!

FLS Module 3 - basic laparoscopic

procedures

What are some of the newest developments in laparoscopic surgery? - answer Robotic assistance, single port site procedures, Natural Orifice Translumenal Endoscopic Surgery (NOTES), and intrauterine fetal surgery List 5 laparoscopic procedures that are performed on newborn infants - answer appendectomy, undescended testes, anti-reflux surgery, pectus repair, PDA, intestinal atresia, pyloromyotomy, and surgery for Hirschsprung's disease Indications for diagnostic laparoscopy - answer elective - cancer staging, chronic abdominal pain urgent - small bowel obstruction, vs ileus Emergent - trauma, suspected iatrogenic injury, perforated viscous During what procedures could you inadvertently enter the peritoneal cavity and subsquently need to perform a diagnostic laparoscopy? - answer hysteroscopy, endoscopy Key elements of performing a lysis of adhesions - answer Use both blunt and sharp dissection with gentle traction on tissue. Be cautious and sparingly use energy sources for hemostasis to avoid thermal spread What is the best position for patients getting surgery on the upper abdomen? - answerArms on arm boards, reverse trendelenburg position with a footboard and safety strap on lower thighs to keep patient from sliding. Monitors placed at head of table for viewing operative field. What is the key to patient positioning? Where would you place your initial port for a diagnostic lap where you need to view the entire abdomen? After your initial port, where do you place additional ones? - answerMaximize the ergonomics of the surgeon and assistant. Usually initiate access in LUQ and 2 additional ports can also be placed in the left abdomen (then surgeon and assistant can stand on left side together). This allows the entire abdomen to be visualized except for immediately below the ports or lateral to the ports. General principles of diagnostic lap of the liver - answerAngled scope Tools for biospy and hemostasis May need ultrasound to visualize structures under the surface. To see anteriorly: may need adhesiolysis To see posteriorly: may need special liver retractor or careful use of blunt instruments

Why would you do a diagnostic lap of the anterior abdominal wall? What area should you enter the abdomen? What degree scope should you use? - answerTo look for evidence of post-op bleeding, adhesions, hernia or tumor. Left upper quadrant, unless the area of interest is in the LUQ. 30 degree scope Best position and port placement for diagnostic pelvic laparoscopy - answer- Tucked arms so surgeon can be ergonomically favorable.

  • Trendelenburg
  • Ports at or above the umbilicus
  • Retract uterus with manipulator or suture retraction to the abdominal wall. Diagnostic lap for suspected appendicitis - answer- Left arm tucked, allowing surgeon and assistant to stand on left side.
  • T-burg
  • Rotate slightly to a "right side up" orientation
  • Secure patient adequately to table What are the anatomic landmarks or the beginning and end of the small bowel? - answerLUQ at ligament of Treitz to RLQ at ileocecal valve Why would you want to have 2 monitors for a diagnostic laparoscopy of the small bowel
  • answerBecause the small bowel spans the entire abdomen both LUQ and RLQ so surgeon and assistant need to stand on both sides of the table (as opposed to some surgeries like appy where both surgeons stand on patient's left and operate on patient's right). In reference to the location next to the patient, what are the best positions for the monitors in laparoscopy? - answerBest monitor positions are by patient's left shoulder and right hip.
    • answerPorts all on left side of abdomen in a line How do you "run the bowel" laparoscopically? - answer- Systematically
  • Start at cecum and work proximally, keep track of where you are to ensure complete examination.
  • Usually requires changing camera angle several times. Tips to avoiding enterotomy when "running the bowel" in laparoscopy? - answer- Use instruments with non-traumatic tips
  • Handle mesenteric fat rather than bowel wall itself
  • Keep instruments in view at all times.

What sort of needle should you use for a FNA in laparoscopy? - answerA spinal needle that can reach target tissue through abdominal wall. What do you need to do with the plunger of your needle for a FNA biopsy before you remove the need from the abdominal cavity? - answerRelease the plunger to release the suction before you remove it from the abdominal cavity. Then detach the needle from the syringe and fill up the syringe with air to push out contents of needle into specimen cup. For what organ would you most commonly perform a core needle biopsy? What guage of needle is it? - answerLiver biopsy

  • cirrhosis or carcinoma
  • Should not do it for a hemangioma (high amount of bleeding) Uses a 14 or 18 guage needle What are laparoscopic biopsy forceps? - answerSpecifically designed laparoscopic instruments for biopsy of organs. Jaws have cutting rim with a hollowed out center to avoid crushing the tissue. What sort of tools do you use to perform a laparoscopic wedge biopsy? - answerUse a scalpel, scissors, or stapling device. Avoid energy source while collecting the sample. Hemostasis obtained after specimen is collected. How much fluid and what fluid type is used to obtain peritoneal washings? - answer- Use 100 cc of 0.9% NS infused unless abundant ascites is present.
  • After 3-5 minutes, fluid is aspirated. Trap fluid before it goes into main suction cannister.
  • Some require heparin to be added to it before being sent to pathology How would you go about performing a peritoneal biopsy (what tools? how do you take it out?) - answer- Directly grasp
  • Excise with scissors
  • Ultrasonic or bipolar scissors
  • Remove through 5 or 10 mm port What type of biopsy is a lymph node biopsy? What is a key principal to all lymph node biopsies? What can you use besides cautery to help get control of vascular supply of a lymph node? - answer- Excisional biopsy
  • Handle gently, prevent excessive damage or bleeding
  • endoloop on nodal lymphvascular supply can be used to avoid damage caused by cautery If you determine malignancy in ovarian biopsy what should you do for a full staging procedure? - answerPeritoneal washings, diaphragm sampling, paracolic gutter sampling bilaterally, para-aortic lymph node sampling

How do you prevent seeding of the abdomen with an ovarian specimen or causing ovarian remnant syndrome? - answerUse a retrieval sac or ensure small specimens are small enough to fit through the port you have in place. After you biopsy a hollow viscous such as bowel, how do you repair it? - answerSerosal suture to avoid leakage post-operatively. Around what types of structures should you avoid monopolar cautery? - answermonopolar cautery should be avoided around vascular structures, ureters or nerves. What types of biopsy are commonly used with ultrasound guidance? - answerCore needle biopsy or FNA What are the benefits to using a braided suture over a monofilament suture for laparoscopy? - answerbraided sutures easier to handle, less tendency to fray, less throws per knot, less memory in the suture Why would you choose a suture that is dyed rather than an undyed suture for laparoscopy? - answerA suture without dye may absorb blood and blend into background making it difficult to use which needle type is safer to use in laparoscopy, tapered or cutting? - answerTapered needles Name two locations for the locking mechanisms for needle drivers in laparoscopy - answer- pistol grip

  • in-line with the handle handle (like a German driver) How far apart should ports be placed from one another? - answerPorts should be at least 10 cm apart. Also, ports need to be far enough away from the operative site to facilitate knot tying/suturing. Ergonomics should be such that the surgeons elbows are flexed at 90 and adjacent to their body. Where should you grasp (i.e. on the suture or on the needle) when introducing the needle into your operative field? - answerGrasp the suture 5-10 mm proximal to its junction with the needle. Minimizes inadvertent organ injury If you have a port <10 mm in size, how can you introduce a needle through that port site? - answer- Take the port out
  • Place your needle driver through the free port and then grasp the suture 5-10mm proximal to needle
  • Place needle through skin followed by port under direct visualization

What size port do you typically need to use a laparoscopic stapling device - answer mm port What staple height is used for vascular structures? GI tract? Distal stomach or unusually thick portions of GI Tract? - answerVascular: 2-2.5 mm (white cartridge) GI tract: 3-3.5 mm (blue cartridge) Stomach or thick GI tissue: 4-4.5 mm (green cartridge) What size trocar will accommodate placing a standard SH type needle through the cannula? - answer10-12 mm trocar What is the ideal suture length for intracorporeal knot tying? (hint, same length as what you are given for the FLS task!) - answer15 cm (6 inches) What is the ideal suture length for extracorporeal knot tying? - answer75 cm (30 inches) What is the ideal orientation for suture (what positions on the face of a clock) - answer o'clock to 9 o'clock What steps should you take to control bleeding intraoperatively? - answerOptimize visualization, grasp and hold the bleeding source, maintain exposure to it, and apply hemostatic techniques When the trocars are placed through what muscle you have the highest risk of injury to the epigastric vessels - answerrectus muscles Name several ways to control bleeding from a port site - answer- Energy source, direct pressure, suture ligation,

  • Pass foley catheter through port site and inflate balloon to tamponade the site If conservative measures fail to control bleeding at a port site, what type of suture can you place? - answerFull thickness abdominal wall suture placed cephalad and cauded to port site through skin incision. Through abdominal wall and into abdominal cavity with either a Keith needle or spinal needle. Causes of retroperitoneal bleeding - answerVerees needle or trocar injury What must you suspect if you have free blood that is clearly not from a port or operative site? - answera retroperitoneal bleed If you identify that you have a retroperitoneal injury what should you also be concerned about? - answerAn occult bowel injury (i.e. you may have passed the verees through bowel and then entered the retroperitoneal space) What do you do if you identify a trocar injury with retroperitoneal hemorrhage - answerUrgent open ex lap

What are the advantages to using bipolar over monopolar electrocautery? - answerUsed for larger vessels, works in a "wet" operative field, less lateral thermal spread and a lower energy requirement.

  • answer