Instruments
What gas is used for insufflation and why?
CO2
Readily absorbs into blood stream
Describe the relationship of the aortic bifurcation to the umbilicus in a patient with obesity and how would you change your entry technique?
lies cephelad to umbilicus
insertion angle 90'
What is the first thing you do after placement of the umbilical trocar and insertion of the laparoscope?
Evaluate for entry trauma
Name 3 nerves that could be injured secondary to lithotomy positioning
common peroneal
femoral
sciatic
obturator
what are 2 different techniques for laparoscopic knot tying?
intracorporeal
extracorporeal
Maryland
Bowel grasper
Tenaculum
Atraumatic grasper
These three broad organ systems are among the major categories of visceral injury that can occur during laparoscopic entry and surgery
vascular, GI urinary
With what size trocar do you need to need to close fascia AND name two technique used to close fasica during laparoscopy
>8mm
Carter-thomason
Direct visualization, i.e after hasson entry
Name 2 patient risk factors for developing complications associated with prolonged trendeleburg positioning?
Obesity
Severe cardiopulmonary disease - asthma, heart failure
elevated IOP
elevated ICP
why would a patient have shoulder pain after laparoscopic surgery?
irritation of the phrenic nerve
Identify these uterine manipulators
V-care
Rumi
Humi
Acorn
Hulka
What intraabdomnial structure can you use to help identify inferior epigastric vessels?
medial umbilical ligament
A patient with significant prior abdominal surgery presents for laparoscopy. What location would you choose for veress needle entry and what is it's name?
LUQ and Palmer's point
What 2 anatomic structures do you use to ensure that patient is positioned appropriately at the end of the OR table?
Sarcum and pubic bone
what specific complication can occur with improper closure of the fascia at lateral port sites
spigelian hernia
describe why you want to use a 0 degree versus 30 degree laparoscope
0 degree for viewing tissue straight-on with intuitive movement of the laparoscope
30 degree to allow a larger field of view and maneuverability into angles/corners
During retroperitoneal dissection, the surgeon identifies this structure crossing the pelvic brim and coursing along the lateral pelvic wall before passing beneath the uterine artery near the cervix
ureter
Describe hasson entry
variable responses
What would your interventions be for a caprini score of 3, 6, 8 and 10?
SCDs
SCDs + consideration of LMWH
SCDs + LMWH x7-10d
SCDs + LMWH x30d
A patient initially appears stable after a difficult laparoscopic procedure involving extensive adhesiolysis. On postoperative day 2, she develops increasing abdominal pain, fever, tachycardia, and leukocytosis. What complication are you most concerned about?
bowel injury
What is the role of the bovie pad when using monopolar electrocautery?
completes the closed electrical circuit back to the electrosurgical unit, preventing electrical energy from concentrating and causing burns
Name the two major pelvic spaces typically developed on either side of the internal iliac vessels
pararectal and paravesical spaces
Name 3 techniques for removing a specimen from the abdominal cavity
Direct removal through port
Endocatch bag
Posterior colpotomy
Immediately after insufflation begins, the anesthesiologist reports abrupt hypotension, hypoxemia, and a sudden decrease in end-tidal CO₂. What rare complication is most likely?
gas embolism
What opening pressure should be looked for when doing veress versus optiview entry techniques to ensure you are in the peritoneal cavity?
<10mmHg
trick question