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FLS Modules Questions with Correct Answers, Exams of Advanced Education

Illinois State University (ISU)Advanced Education

FLS Modules Questions with Correct Answers

Typology: Exams

2024/2025

Available from 07/07/2025

johniewalker91
johniewalker91 🇺🇸

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FLS Modules
Laparoscopic instruments diameter and length ranges - answer2-10mm, 30-45cm
Hopkins rod lens - answer light has to travel back through the rod to capture the image.
Decreasing light in the camera for... - answer decreasing diameter, increasing scope
angle (ie 5mm and 30 degree has less light than 10mm 0 degree)
When is zero degree scope most useful - answer when working in a small area directly
in line with the scope and ports, like the pelvis
how to check fiber optics light connection - answer black dots= broken fibers
why does it fog up? - answer temperature and humidity discrepancy between the OR
and body
tools for defogging - answer FRED antilog (must dry before putting back in), put
laparoscope in hot water
methods to clean a smudged lens - answer gently wipe on clean tissue (liver, uterus,
bowel), remove scope and clean with hot water and gauze
Insufflation gas type and reasoning - answerCO2- readily available, inexpensive, non
combustable, warmed and humidified better
high flow insufflation - answer10 or more L per minute
preventing loss of pneumo with suctioning - answerkeep suction tip below the fluid level
most common light source - answer300W xenon lamp
Troubleshooting steps: gas preOP - answer1. check that co2 tank is full
2. check co2 tank gasket is secured
3. check that spare co2 tank is available in the OR
troubleshooting steps: image - answer1. check that the monitor is plugged in and turned
on 2. check that all cables are connected securely
troubleshooting steps: loss of working space: insufflator settings: measured pressure is
the same or higher than the preset pressure - answer1. the patient may not be
adequately relaxed or there is a mechanical block of gas flow
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FLS Modules

Laparoscopic instruments diameter and length ranges - answer2-10mm, 30-45cm Hopkins rod lens - answer light has to travel back through the rod to capture the image. Decreasing light in the camera for... - answer decreasing diameter, increasing scope angle (ie 5mm and 30 degree has less light than 10mm 0 degree) When is zero degree scope most useful - answer when working in a small area directly in line with the scope and ports, like the pelvis how to check fiber optics light connection - answer black dots= broken fibers why does it fog up? - answer temperature and humidity discrepancy between the OR and body tools for defogging - answer FRED antilog (must dry before putting back in), put laparoscope in hot water methods to clean a smudged lens - answer gently wipe on clean tissue (liver, uterus, bowel), remove scope and clean with hot water and gauze Insufflation gas type and reasoning - answerCO2- readily available, inexpensive, non combustable, warmed and humidified better high flow insufflation - answer10 or more L per minute preventing loss of pneumo with suctioning - answerkeep suction tip below the fluid level most common light source - answer300W xenon lamp Troubleshooting steps: gas preOP - answer1. check that co2 tank is full

  1. check co2 tank gasket is secured
  2. check that spare co2 tank is available in the OR troubleshooting steps: image - answer1. check that the monitor is plugged in and turned on 2. check that all cables are connected securely troubleshooting steps: loss of working space: insufflator settings: measured pressure is the same or higher than the preset pressure - answer1. the patient may not be adequately relaxed or there is a mechanical block of gas flow
  1. inspect abdomen for rhythmic muscle contraction and palpate the abdomen for firmness
  2. check port valves to make sure they are open
  3. check for kinks in tubing and make sure no one is standing on them troubleshooting steps: loss of working space: insufflator settings: low pressure and high flow rate - answer1. there is a leak in the insufflation circuit
  4. check that the tubing has not become disconnected from insufflator or port
  5. check that all valves are closed
  6. check all port sites for leaking co
  7. check for foley catheter bag distention or bowel distention troubleshooting steps: loss of working space: insufflator settings: low pressure and no flow - answer1. make sure that the insufflator power is on
  8. check gas level in the tank troubleshooting steps: loss of working space: complete loss of operative image - answer1. check for disconnected power cords, video cables
  9. check for blown light source bulb
  10. check for disconnected light cable Monopolar electrosurgery curcuit - answerelectrical surgical unit-->active electrode--

patient tissue-->dispersive electrode (grounding pad) low frequency from wall source to high frequency at active electrode monopolar: tissue coagulation - answeroccurs as a result of tissue heating and protein denaturation. monopolar: desiccation - answertissue temp rises--->water is evaporated from the tissue--> increased impedance---> electricity stops flowing because of increased resistance-->tissue turns brown, bubbles and steams. Hemostasis due to fibrous binding between dehydrated, denatured cells of vessel endothelium monopolar: current density - answeramount of current flowing through cross sectional area. directly proportional to power, inversely related to tissue resistance ie larger the area, less current density monopolar: cut mode - answerheat tissue quickly. cell water is converted to steam, causing the cell to explode. minimal later thermal tissue damage, but poor thermal

important history to consider preOP (5) - answer1. history of DVT/PE

  1. hx radiation
  2. hx hip prosthetics
  3. sig cardiopulmonary conditions (important to continue throughout preoperative period)
  4. need for stress dose steroids NSAIDs including ASA - answerdo not need to be discontinued ASA level not appropriate for lap surgery - answer4-5, might not be able to tolerate pneumoperitoneum due to decreased venous return and need for hyperventilation obese patients: trocar insertion - answeruse of longer trocars (up to 100mm) thin patients: trocar insertion - answer1. elevate abdomen
  5. consider placing veress needle away from the midline near the costal margin
  6. consider utilizing open approach or visiport for direct visualization contraindications to laparoscopy: absolute (4) - answer1. inability to tolerate laparotomy
  7. hypovolemic shock
  8. lack of proper surgical training
  9. lack of appropriate institutional support contraindications to laparoscopy: relative (5) - answer1. inability to tolerate general anesthesia
  10. long standing peritonitis (can increase risk of injury on trocar insertion)
  11. large abdominal or pelvic mass
  12. massive incarcerated ventral and inguinal hernias (can have loss or peritoneal space)
  13. severe cardiopulmonary disease (intolerance to proper positioning) R/B ratio dictates preoperative precautions for laparoscopy (10) - answer1. visceral arterial aneurysm ( risk of injury with trocar insertion)
  14. previous abdominal surgery (adhesions, risk of enterotomy)
  15. history of peritonitis (higher risk of adhesions)
  16. umbilical abnormalities (difficulty gaining access or closing fascia)
  17. previous ventral hernia repair with mesh (risk of difficult entry, closing abdominal wall)
  18. hepatosplenomegaly (risk of solid organ injury)
  19. cirrhosis (risk of bleeding and post op ascites)
  20. intestinal obstruction (risk of eneteromy and decreased visualization)
  21. pregnancy
  22. thin body habitus lap cholecystectomy relative contraindications (5) - answer1. gallbladder cancer
  1. portal HTN
  2. cirrhosis
  3. acute cholecystitis
  4. mirizzi syndrome lap colon resection relative contraindications (4) - answer1. large fixed mass
  5. dense pelvic adhesions
  6. massive bowel dilation
  7. t4 tumors lap appendectomy relative contraindications (2) - answer1. phlegmon
  8. large abscess emergency laparoscopy relative contraindications (3) - answer1. longstanding peritonitis
  9. hemodynamic instability paritally correctable with resuscitation
  10. massive bowel dilation pelvic laparoscopy relative contraindications (2) - answer1. large fixed mass
  11. inability to tolerate trendelenberg lap foregut procedures relative contraindications (2) - answer1. previous gastric operation at GE juntion
  12. hepatosplenomegaly lap antireflux surgery relative contraindications (5) - answer1. esophogeal shortening
  13. epithelial dysplasia
  14. previous gastric surgery at GE juntction
  15. liver enlargement
  16. large hiatal hernia lap hernia repair relative contraindications (4) - answer1. large, chronically incarcerated hernia
  17. acutely incarcerated hernia
  18. need for removal of large prosthetics
  19. ned for skin graft removal o large scar revision things that are NOT contraindications (commonly mistaken) (9) - answer1. diaphragm injury
  20. GI bleed
  21. perforated viscus
  22. bowel obstruction
  23. abdominal trauma
  24. IUP or ectopic preg
  25. obesity
  26. COPD
  27. renal insufficiency

complications of veress needle insertion (8) - answer1. bowel injury

  1. mesenteric or omental vascular injury
  2. retroperitoneal vascular injury
  3. cardiac arrhythmia
  4. hypotension
  5. high airway pressures
  6. pneumothorax
  7. gas embolism hasson technique - answer1. 2 cm skin incision
  8. carried down through the skin and subQ
  9. expose fascia
  10. incise fascia with scalpel or bovie
  11. place anchoring sutures in fascia while well exposed
  12. dissect through pre-peritoneal fat and identify peritoneum
  13. grasp peritoneum , elevate, incise
  14. blunt tip trochar is inserted under direct visualization and secured to the fascia with the stay sutures things to monitor with co2 pneumoperitoneum (6) - answer1. cardiac rhythm
  15. pulse ox
  16. end tidal co
  17. heart rate
  18. BP
  19. urine output CO2 chemical effects - answer1. increases arterial co2 concentration--> drop in serum pH
  20. increases end tidal co2 (greatest change In the first 20 minutes) pulmonary physiology with co2 pneumo - answer1. increased minute ventilation to eliminate absorbed CO
  21. reduced functional residual capacity (because of increased intra-abominal pressure)
  22. increased peak airway pressure
  23. reduced pulmonary compliance overview of cardiovascular effects of co2 pneumo - answer1. systemic vascular changes
  24. cerebral auto regulation of blood flow
  25. vagal responsiveness to reverse trendenenberg
  26. increased venous stasis because of pressure in peritoneum (need for use of VTE ppx) Alternative gases: NO - answerbenefits: less acid-base disturbance, increased patient tolerability in patients with severe cardio pulmonary disease, less post op pain

risks: fire hazard with electrocautery, cannot be used with suspected bowel perf alternative gases: Argon and Helium - answereliminate the complication of acidosis, but are much less soluble in blood. Decreased solubility increases the risk of extra- peritoneal gas extravasation (gas embolus) cardiovascular effects of pneumo - answer1. increased preload

  1. increased afterload
  2. decreased CO decrease in CO - answerExacerbated by reverse trendelenburg and hypovolemia. may be caused by vagally induced bradycardia what to do if decreased CO intraop (5) - answer1. desufflate immediatey
  3. check insufflator setting and fuctions
  4. check for adequate relaxation
  5. check intravascular volume status
  6. check for other causes of hypotension cardiac arrhythmia due to pneumoperitoneum (3) - answer1. sinus tach (most common, self limited)
  7. PVCs
  8. bradycardia (due to pressure effect, vagally mediated) Renal effects of pneumoperitoneum - answer1. increased intrabdominal pressure decreases renal blood flow--> intra-op oliguria is common
  9. renin and ADH release results in Na and free water resorption
  10. post-op oliguria should resolve within a few hours
  11. don't fluid overload--> CHF hypothermia related to pneumo - answeruse humidified and warmed gas, warm IVF, bear hugger, warm irrigation, warm air temp extraperitoneal gas extravasation can cause (4) - answer1. subcutaneous gas
  12. thoracic gas
  13. delayed co2 toxicity
  14. gas embolus gas embolus - answer- occurs in less than 1% of cases
  • diagnosis: sudden CV collapse due to impaired venous return to the heart. JVD, hypotension, tachycardia, mill wheel murmur -treatment: cessation of insufflation, fluid administration, trendelenberg with L side down position prevent embolus from traveling, central line into Right heart to break up embolus

biopsy forceps - answerfor incisional or excisional, or peritoneal implants. wedge biopsy - answerutilize scalpel, scissors, or staple device. can be excisional or incisional. peritoneal washings/scrapings - answerobtain prognostic information that may guide further therapy. obtain early in staging lap. 100cc of 0.9%NS unless there is abundant ascites. aspirate after 3-5 minutes. liver biopsy - answergenerally for parenchymal disease. ex cirrhosis. Core needle or wedge biopsy. ovary biopsy - answeroophorectomy vs wedge resection vs biopsy forceps based on menopausal status, suspicion for malignancy. avoid seeding abdominal wall with specimen biopsy of visceral lesions - answerif small and superficial can excise, use serosal stitch to avoid leakage retroperitoneal bx - answerto assess LN or unidentified mass. US may be used. monopolar may be used but not in the vicinity of vasculature or nerves. hemostasis after biopsy (6) - answerobtained secondarily to avoid thermal injury to specimen

  1. direct pressure
  2. monopolar
  3. bipolar
  4. ultrasonic
  5. topical hemostatic agents
  6. sutures benefits of braided suture - answereasier to handle, lack elastic memory, don't fray dyed sutures preferred because? - answerdon't blend in with blood intracorporeal knot tying ergonomics - answerelbows flexed at 90 degrees and ports at least 10cm apart interrupted vs continuous sutures - answer1. interrupted less cumbersome but each requires a knot
  7. continuous needs constant tension (done with assistant's help and/or intermittently locking the throws) extracorporeal knot length - answer30 inches or 75cm

minimize tissue friction extracorporeal knot - answeruse instrument as a fulcrum, because of the 180 degree angle roedner's knot - answertied completely exrtraporporeally then pushed down. used for: blood vessels, appendix, fallopian tube, cut end of cystic duct linear staplers - answer2-3 rows of staples on either side of knife blade require 12 mm port generally choice of staple height - answer1. vascular: 2-2.5mm

  1. GI tract 3-3.5 mm
  2. distal stomach or thickened GI tract 4-4.5 mm removing ports under direct lap visualization because: - answerbleeding may not be evident during procedure, and may not be evident externally after port is removed. when to use monopolar for hemostasis - answersmall vessels, slow rate of bleeding, need a relatively dry operative field when to use bipolar for hemostasis - answerlarger vessels, works in wet operative field, less lateral thermal spread, lower energy requirement risk factors for PONV (8) - answer1. female
  3. young
  4. history of PONV
  5. motion sicknress
  6. non smokers 6.use of NO or volatile anesthetics
  7. opiods
  8. longer procedure length prevention of PONV - answer1. use 5HT3 receptor antagnists and h1 receptor antagonists
  9. limit opiods
  10. local and regional anesthetic if poss
  11. avoid NO shoulder pain - answerlasts 1-3 days treat the same as incisional pain post op injuries that occur later (4) - answer1. partial thickness injruies
  12. non visualized electrosurgical burn
  13. anastomotic leak
  14. devascularization/ichemia