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Fundamentals of Laparoscopic Surgery Questions with Solutions, Exams of Advanced Education

Illinois State University (ISU)Advanced Education

Fundamentals of Laparoscopic Surgery Questions with Solutions

Typology: Exams

2024/2025

Available from 07/07/2025

johniewalker91
johniewalker91 🇺🇸

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Fundamentals of Laparoscopic Surgery
Describe a monopolar energy route? - Answer-electrode > tissue > patient > return pad
Describe a bipolar energy route? - answer-electrode > tissue > electrode
--> electrodes shaped like forceps
Three modes of monopolar devices? - answer-cut
-coagulation
-blending
Describe the mechanism of monopolar cutting? - answer-heats tissue quickly > converts
water to steam > causes cells to explode
Describe the mechanism of monopolar coagulation? - answer-rapid surface heating
What is current diversion and when does it occur? - answer-when current passes
through unintentional tissue following the path of least resistance
What precautions should surgeons take when utilizing laparoscopy? - answer-inspect
insulation carefully
-use lowest possible power setting
-use lowest voltage waveform possible
-use brief intermittent activation vs. prolonged activation
-do not active unless in close proximity to target tissue
-do not activate in close proximity to another instrument
-use bipolar instrumentation when possible
What is capacitative coupling? - answer-the transfer of energy within an electrical
network or between distant networks by means of displacement current between circuit
nodes, induced by the electric field
What is direct coupling? - answer-the the transfer of electrical energy by means of
physical contact via a conductive medium (such as between two instruments)
When is a narrow return circuit formed? - answer- applying monopolar heat to a narrow
piece of tissue, etc. ligated tissue like an appendiceal stump
Bipolar instruments can seal vessels up to what diameter? - answer-7 mm
Hazards of using bipolar instruments? - answer-inadvertent thermal injury (lateral
spread)
-inadvertent cutting of patent vessel before adequate sealing
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Fundamentals of Laparoscopic Surgery

Describe a monopolar energy route? - Answer-electrode > tissue > patient > return pad Describe a bipolar energy route? - answer-electrode > tissue > electrode --> electrodes shaped like forceps Three modes of monopolar devices? - answer-cut -coagulation -blending Describe the mechanism of monopolar cutting? - answer-heats tissue quickly > converts water to steam > causes cells to explode Describe the mechanism of monopolar coagulation? - answer-rapid surface heating What is current diversion and when does it occur? - answer-when current passes through unintentional tissue following the path of least resistance What precautions should surgeons take when utilizing laparoscopy? - answer-inspect insulation carefully -use lowest possible power setting -use lowest voltage waveform possible -use brief intermittent activation vs. prolonged activation -do not active unless in close proximity to target tissue -do not activate in close proximity to another instrument -use bipolar instrumentation when possible What is capacitative coupling? - answer-the transfer of energy within an electrical network or between distant networks by means of displacement current between circuit nodes, induced by the electric field What is direct coupling? - answer-the the transfer of electrical energy by means of physical contact via a conductive medium (such as between two instruments) When is a narrow return circuit formed? - answer- applying monopolar heat to a narrow piece of tissue, etc. ligated tissue like an appendiceal stump Bipolar instruments can seal vessels up to what diameter? - answer-7 mm Hazards of using bipolar instruments? - answer-inadvertent thermal injury (lateral spread) -inadvertent cutting of patent vessel before adequate sealing

-improper device function if metal is contained within the jaws The harmonic is an example of what type of device? - answer-piezoelectric transducer The use of all plastic or all metal trocars can avoid which problem during electrosurgery? - answer-capacitative coupling Surgeons should have their arms how many degrees away from their body? - answer< 30 degrees Elbows should be flexed between...? - answer60 to 120 degrees Consideration for patients on steroids or immunosuppressive drugs? - answer- delayed healing

  • may need stress dosing When should warfarin be discontinued before surgery? What about NSAIDs? - answer- at least three days for anticoagulants
  • No evidence for d/c NSAIDs prior to laparoscopy Any proof that NSAIDs need to be discontinued before surgery? - answer-no ASA class one? - answer-no disturbance ASA class two? - answer-mild to moderate systemic disease ASA class three? - answer-severe systemic disease What patients may not be suitable for LSC surgery? - answer-ASA 4 and 5 Typical length of trocars be in obsese patients? - answer-greater than 100 mm Approaches to minimizing complications during entry in thin patients? - answer- elevating abdominal wall -place veress near costal margin -use hassan open approach or direct entry Absolute contraindications to laparoscopy? - answer-hypovolemic shock -lack of training -lack of institutional support -inability to tolerate laparotomy Relative contraindications to laparoscopy? - answer-inability to tolerate general anesthesia (if can't be performed under local) -long-standing peritonitis -large abdominal or pelvic mass

-renal insufficiency Local anesthesia indications? - answer-Dx LSC -Tubal ligation -Select inguinal hernia repairs When the arms are at > 90 degrees abduction when patients are supine, there is the risk of...? - answer-brachial plexus injury What can be used to prevent brachial plexus injury when patients are in the lateral decubitus position? - answer-roll in the axilla on the dependent side

  • upper arm on a sling or elevated surface What can be used to prevent pressure injuries when patients are in the left lateral decubitus position? - answer-bean bag What can be used to increase access to the kidneys/adrenal glands? - answer-flexing of OR table > increases distance between costal margin and iliac crest What surgeries can be performed using the modified decubitus position? - answer- splenectomy -nephrectomy -adrenalectomy

allows removal of large specimens After inserting the veress and insufflating, what should the peritoneum be at before placing the initial trocar? - answer-10 to 15 mm Hg (1-3 L CO2) Relative contraindications to blind initial trocar insertion? - answer-prior abdominal surgery -prior intra-abdominal inflammatory process Absolute contraindications to blind initial trocar insertion? - answer-abdominal scar from prior operation close to vicinity -through previously placed intraperitoneal mesh Complications of pneumo/initial trocar placement? - answer-bowel injury -mesenteric injury -omental injury -retroperitoneal injury -cardiac arrhythmia -hypotension -high airway pressures -pneumothorax -gas embolism

Why is CO2 the preferred gas to establish pneumoperitoneum? - answer-rapidly absorbed -easily eliminated (diffusion coefficient >20x that of O2) -suppresses combustion -readily available -inexpensive Chemical effects of CO2 pneumoperitoneum? - answer-increases arterial CO concentration -increased end-tidal CO -decrease serum pH ** Greatest change occurs in the first 20 minutes of CO2 pneumoperitoneum Pulmonary physiology of CO2 pneumoperitoneum? - answer-increased minute ventilation (d/t rapid lung absorption) -reduced FRC -increased peak airway pressure -reduced pulmonary compliance Benefits of nitrous oxide vs. CO2? - answer-less acid-base disturbance -tolerated better with severe cardio-pulmonary disease -slightly less postoperative pain Major risk of using nitrous oxide? - answer-fire hazard if using electrocautery in the presence of open bowel (supports combustion) Downsides of using Argon and Helium? - answer-increased risk of gas embolus (decreased solubility in blood = increased extravasation) -more expensive Impact of CO2 on heart? - answerincreased preload increased afterload decreased cardiac output Why does this occur? - answer-due to both chemical and pressure effects Decrease in cardiac output during pneumoperitoneum is exacerbated by...? - answer- reverse trendeleberg -hypovolemia -vagal induced bradycardia (e.g., in response to Trendelenberg) Next steps if there are signs that pneumoperitoneum is decreasing cardiac output? - answer-desufflate immmediately -check insufflator settings -check for adequate relaxation -check intravascular volume status

What type of trocar will accommodate a standard SH type needle? - answer-10 to 12 mm Ideal suture length for intracorporeal knot tying? - answer-15 cm Symptoms of retroperitoneal bleeding? - answer-retroperitoneal hematoma -mesenteric hematoma -free blood not from port or operative site -hypovolemic shock Treatment for retroperitoneal bleeding? - answer-temporary control laparoscopically > conversion to laparotomy When should monopolar electrocautery be used for hemostasis? - answer-smaller vessels -slow rate of bleeding -need dry operative field When should bipolar electrocautery be used for hemostasis? - answer-larger vessels -wet operative field -less lateral thermal spread -lower energy requirement How does ultrasonic coagulation work? - answer- Vibrating blade generates heat and compresses tissue against a passive blade to cut and coagulate Important components from preop PMH? - answerPrior abdominal or pelvic surgery Prior abdominal radiation or chemo ports Internal prostheses Pulmonary or cardiac disease Prior coagulopathy or VTE Prior complications with anesthesia What is the current density? - answerthe amount of current per unit area What is always the first step after inserting the laparoscope? - answerVisualizing the area directly below the trocar to confirm no injury What effect does pneumoperitoneum have on venous return and why is it important? - answerIncreased resistance in the vena cava --> Decreased lower extremity venous flow rate --> Increased risk of VTE What are risk factors for VTE during surgery? - answerDuration over 1h Pelvic procedures Hx VTE, varicose veins, immobility

Age > 40 HRT, OCP use Peripartum Multiparity CHF, MI, Chronic renal failure, Cancer Severe infection IBD Obesity What are the renal effects of pneumoperitoneum? - answerintraoperative oliguria postoperative oliguria (usually for a couple hours)

  • if persistent postop oliguria, monitor and investigate, don't auto-bolus