FLS EXAM (ACTUAL EXAM) FUNDAMENTALS OF
LAPAROSCOPIC SURGERY EXAM VERIFIED
QUESTIONS AND ANSWERS LATEST UPDATE
Describe the mechanism of monopolar coagulation? - -rapid surface heating
What is current diversion and when does it occur? - -when current passes through unintentional
tissue following the path of least resistance
What precautions should surgeons take when utilizing laparoscopy? - -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
Describe a monopolar energy route? - -electrode > tissue > patient > return pad
Describe a bipolar energy route? - -electrode > tissue > electrode
--> electrodes shaped like forceps
,Three modes of monopolar devices? - -cut
-coagulation
-blending
Describe the mechanism of monopolar cutting? - -heats tissue quickly > converts water to
steam > causes cells to explode
What is capacitative coupling? - -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? - -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? - -when a monopolar instrument comes into contact
with a ligated tissue
Bipolar instruments can seal vessels up to what diameter? - -7 mm
Hazards of using bipolar instruments? - -inadvertent thermal injury
-inadvertent cutting of patent before adequate sealing
-improper device function if metal is contained within the jaws
The harmonic is an example of what type of device? - -piezoelectric transducer
The use of all plastic or all metal trocars can avoid which problem during electrosurgery? - -
capacitative coupling
Surgeons should have their arms how many degrees away from their body? - -30 degrees
Elbows should be flexed between...? - -60 to 120 degrees
Consideration for patients on steroids or immunosuppressive drugs? - -may need stress dosing
When should warfarin be discontinued before surgery? - -three days
Any proof that NSAIDs need to be discontinued before surgery? - -no
ASA class one? - -no disturbance
ASA class two? - -mild to moderate systemic disease
ASA class three? - -severe systemic disease
What patients may not be suitable for LSC surgery? - -ASA 4 and 5
How long should trocars be in obsese patients? - -greater than 100 mm
, Approaches to minimizing complications during entry in thin patients? - -elevating abdominal
wall
-place veress near costal margin
-use hassan open approach or direct entry
Absolute contraindications to laparoscopy? - -hypovolemic shock
-lack of training
-lack of institutional support
-can't tolerate laparotomy
Relative contraindications to laparoscopy? - -inability to tolerate general anesthesia
-long-standing peritonitis
-large abdominal or pelvic mass
-massive incarcerated ventral and inguinal hernias
-severe cardiopulmonary disease
Contraindications to LSC cholecystectomy? - -gallbladder cancer
-portal HTN
-cirrhosis
-acute cholecystitis
-mirizzi syndrome
Contraindications to LSC colon resection? - -large fixed mass
-dense pelvic adhesions
-massive bowel dilation
-T4 tumors
Contraindications to LSC appendectomy? - -phlegmon
-large abscess
Contraindications to emergency LSC? - -longstanding peritonitis
-hemodynamic instability
-massive bowel dilation
Contraindications to pelvic LSC? - -large fixed mass
-inability to tolerate trendelenberg
Contraindications to LSC foregut procedures? - -previous gastric operation
-hepato-splenomegaly
Contraindications to LSC anti-reflux surgery? - -esophageal shortening
-epithelial dysplasia
-previous gastric surgery
-liver enlargement
-large hiatal hernias
Contraindications to LSC hernia repair? - -chronically or acutely incarcerated hernia
-need for removal of prosthetics
-need for skin graft removal or large scar revision
LAPAROSCOPIC SURGERY EXAM VERIFIED
QUESTIONS AND ANSWERS LATEST UPDATE
Describe the mechanism of monopolar coagulation? - -rapid surface heating
What is current diversion and when does it occur? - -when current passes through unintentional
tissue following the path of least resistance
What precautions should surgeons take when utilizing laparoscopy? - -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
Describe a monopolar energy route? - -electrode > tissue > patient > return pad
Describe a bipolar energy route? - -electrode > tissue > electrode
--> electrodes shaped like forceps
,Three modes of monopolar devices? - -cut
-coagulation
-blending
Describe the mechanism of monopolar cutting? - -heats tissue quickly > converts water to
steam > causes cells to explode
What is capacitative coupling? - -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? - -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? - -when a monopolar instrument comes into contact
with a ligated tissue
Bipolar instruments can seal vessels up to what diameter? - -7 mm
Hazards of using bipolar instruments? - -inadvertent thermal injury
-inadvertent cutting of patent before adequate sealing
-improper device function if metal is contained within the jaws
The harmonic is an example of what type of device? - -piezoelectric transducer
The use of all plastic or all metal trocars can avoid which problem during electrosurgery? - -
capacitative coupling
Surgeons should have their arms how many degrees away from their body? - -30 degrees
Elbows should be flexed between...? - -60 to 120 degrees
Consideration for patients on steroids or immunosuppressive drugs? - -may need stress dosing
When should warfarin be discontinued before surgery? - -three days
Any proof that NSAIDs need to be discontinued before surgery? - -no
ASA class one? - -no disturbance
ASA class two? - -mild to moderate systemic disease
ASA class three? - -severe systemic disease
What patients may not be suitable for LSC surgery? - -ASA 4 and 5
How long should trocars be in obsese patients? - -greater than 100 mm
, Approaches to minimizing complications during entry in thin patients? - -elevating abdominal
wall
-place veress near costal margin
-use hassan open approach or direct entry
Absolute contraindications to laparoscopy? - -hypovolemic shock
-lack of training
-lack of institutional support
-can't tolerate laparotomy
Relative contraindications to laparoscopy? - -inability to tolerate general anesthesia
-long-standing peritonitis
-large abdominal or pelvic mass
-massive incarcerated ventral and inguinal hernias
-severe cardiopulmonary disease
Contraindications to LSC cholecystectomy? - -gallbladder cancer
-portal HTN
-cirrhosis
-acute cholecystitis
-mirizzi syndrome
Contraindications to LSC colon resection? - -large fixed mass
-dense pelvic adhesions
-massive bowel dilation
-T4 tumors
Contraindications to LSC appendectomy? - -phlegmon
-large abscess
Contraindications to emergency LSC? - -longstanding peritonitis
-hemodynamic instability
-massive bowel dilation
Contraindications to pelvic LSC? - -large fixed mass
-inability to tolerate trendelenberg
Contraindications to LSC foregut procedures? - -previous gastric operation
-hepato-splenomegaly
Contraindications to LSC anti-reflux surgery? - -esophageal shortening
-epithelial dysplasia
-previous gastric surgery
-liver enlargement
-large hiatal hernias
Contraindications to LSC hernia repair? - -chronically or acutely incarcerated hernia
-need for removal of prosthetics
-need for skin graft removal or large scar revision
