Surgical Procedures Extra Quesions

1. Safety measures to prevent laparoscopic electrosurgical complications include all of the following except:

2. The following statements regarding energy sources in endoscopy are true except:

3. All of the following risks can commonly occur with diagnostic hysteroscopy except:

4. Ms. XY is 35 years old. She is a Para 3 with two previous caesarean sections and desires permanent contraception. She has opted to have a laparoscopic tubal occlusion/sterilisation procedure. Her BMI is 33. She has had two failed attempts at Veress needle insertion through the umbilical route. Which of the following treatment options are best suited to her?

5. All of the following are safe surgical principles during placement of a primary trocar in laparoscopic surgery except:

6. The best route to perform a hysterectomy (if technically feasible) is:

7. Defibulation is the reversal of female genital mutilation (infibulation) and is carried out to restore the anatomy to help minimise obstetric complications. Which of the following statements is correct about defibulation?

8. The most effective method of preventing enterocele formation after vaginal hysterectomy is:

9. Which of the following is least likely to be a complication of lower segment caesarean section?

10. Ms. XY, 48 years old, a Para 3, is due to undergo a NovaSure endometrial ablation in theatre for heavy menstrual bleeding. A WHO surgical safety checklist is in progress. Which of the following components of the checklist need to be completed before the surgical procedure begins?

11. Which type of ureteric injury is most commonly reported at laparoscopy?

12. During laparoscopic pelvic surgery, which visceral structure is most likely to be damaged?

13. Theoretically, what kind of injury related to laparoscopic entry should be reduced by the Hasson (open) technique, compared to a Veress needle entry?

14. An 18-year-old nulliparous girl presents as a gynaecological emergency with severe left-sided pelvic pain, tachycardia and vomiting. A pregnancy test is negative. An ultrasound scan is performed in the emergency department, which appears to demonstrate a left adnexal cyst.

In theatre, a laparoscopy is performed which shows an ovarian torsion that has twisted three times on its pedicle. The left tube and ovary appear purple and congested.

What is the most appropriate surgical management?

15. A patient undergoes a laparoscopic cystectomy for a dermoid cyst and some spillage of the contents occurs into the peritoneal cavity. What will be the incidence of chemical peritonitis?

16. When comparing robotic-assisted surgery to conventional laparoscopic surgery for gynaecological procedures, what would be the major drawback?

17. A 19-year-old is undergoing a laparoscopy for pelvic pain What is the estimated risk of death due to a patient undergoing a laparoscopy?

18. A 22-year-old is undergoing a laparoscopy for suspected endometriosis.

What is the estimated risk of bowel, bladder or blood vessel injury?

19. Consent is being obtained from a 24-year-old for a diagnostic laparoscopy and it is correctly documented that there is a risk of laparotomy if any injury to bowel, bladder or blood vessels were to occur during the procedure.

The patient wishes to know what proportion of cases would be con- verted to a laparotomy should an injury occur?

20. A healthy 54-year-old lady is due to attend the outpatient post- menopausal bleeding hysteroscopy clinic. Which medication should she be advised to consider taking prior to her attendance at the clinic?

21. A 62-year-old is due to undergo a hysteroscopy due to a thickened endometrium detected as part of her investigations for postmenopausal bleeding.

Which medication should be used to ‘prime’ the cervix prior to the hysteroscopy?

22. A 43-year-old lady with a history of heavy menstrual bleeding and a scan suggesting a polyp is due to undergo an outpatient hysteroscopy.

Which distension medium is routinely recommended due to its improved quality of image and speed of the procedure?

23. A 32 year old is due to undergo a laparoscopic operation for investigation and management of an ovarian cyst detected on scan. What is the expected serious complication rate following a laparoscopy?

24. With respect to instrumentation of the uterus, which operation has the highest risk of perforation?

25. What is the most frequently encountered complication of suction evacuation of the uterus for first trimester miscarriage?

26. A 19-year-old woman is to undergo a laparoscopy for pelvic pain. How would you describe the correct technique for entry with the veress needle?

27. What is the most common complication of the bottom up single- incision retropubic tape procedure?

28. You have attempted to perform a direct entry for your laparoscopy and opted to undertake a Palmer’s point entry.

29. A laparoscopic hysterectomy has been completed and several port sizes have been used.

When the port is in the midline, what size of port requires closure of the rectus sheath?

30. A laparoscopy oophorectomy has been completed and the port sites are about to be closed.

What diameter of nonmidline port site required closure of the rectus sheath?

31. A woman is due to undergo an outpatient hysteroscopy and is concerned about pain. Which hysteroscope is associated with the least discomfort in the outpatient setting?

32. A woman is due to undergo an outpatient hysteroscopic polypectomy using a bipolar resectoscope.

Which distension medium should be used?

33. A woman is due to undergo a routine diagnostic laparoscopy. According to RCOG data what is the expected incidence of bowel injury during a laparoscopy?

34. A woman with a stage 3 uterine prolapse is considering a variety of surgical options.

She understands the potential benefits of a mesh repair but is concerned about the risk of mesh erosion. What is the risk of mesh erosion for a patient undergoing a subtotal hysterectomy with sacrocolpopexy?

35. A woman had a total abdominal hysterectomy in the past using a lower transverse incision.

She has now developed a persistent ovarian cyst and is due to have a laparoscopic bilateral salpingo-oophorectomy.

What will be the incidence of adhesions in the region of the umbilicus in this scenario?

36. A morbidly obese woman is due to undergo a total laparoscopic hysterectomy for endometrial cancer. What type of complication is more common compared to traditional open hysterectomy in this situation?

37. A woman has been offered a sacrocolpopexy for a vault prolapse. Her friend had a similar operation but developed stress incontinence following the procedure.

What is the incidence of de novo stress incontinence after a sacrocolpopexy?

38. What investigation would you use to diagnose the presence of a urethral diverticulum?

39. A 45-year-old multiparous woman is due to have a hysterectomy for heavy menstrual bleeding. The patient is considering having a subtotal hysterectomy as she has had normal cervical smears history.

When comparing a subtotal hysterectomy to a total hysterectomy, which perioperative complication is reduced?

40. At the end of a total laparoscopic hysterectomy (in which the woman was placed in a steep Trendelenburg position) you observe that the woman’s shoulder brace was placed too laterally.

What type of nerve injury may present in the postoperative period?

41. You are assisting your consultant in a radical hysterectomy and bilateral pelvic lymphadenectomy. Which of the following instruments will you use to grasp the nodal tissue?

42. A 29-year-old para 1 undergoes a radical hysterectomy with bilateral pelvic lymphadenectomy for Stage 1B squamous cell carcinoma of the cervix. Which of the following is not a routine step in this procedure?

43. Suture materials have different physical properties. Which of the following is the property by which a suture is capable of supporting acute angulation without breaking or opposing excessive resistance?

44. Polydioxanone (PDS) is synthetic, absorbable mono lament surgical suture material. It is particularly useful when a combination of an absorbable suture and extended wound support is desirable.

Which of the following best describes the breaking strength retention (tensile strength) of 3-0 PDS at 6 weeks?

45. You see a 38-year-old para 2 in your gynaecology outpatient clinic who presents with an 8-month history of lower abdominal pain and menorrhagia. A pelvic ultrasound scan shows an enlarged uterus with multiple intramural broids, the largest of which is 8 cm in diameter. Her haemoglobin level is 88 g/L. You discuss hysterectomy a er a course of GnRH analogue.

Which of the following best describes the effect of GnRH analogue on the volume of the uterine fibroids?

46. You see a 28-year-old woman with a 2-year history of primary subfertility in your preoperative assessment clinic. She is booked for hysteroscopic resection of a type 1 submucous fibroid, and you obtain her consent for the procedure.

What is the risk of fluid overload associated with operative hysteroscopy?

47. A 64-year-old para 4 is undergoing a vaginal hysterectomy for procidentia. At the end of the anterior vaginal wall closure the vaginal vault could be pulled to the introitus. What is the most appropriate next step to avoid vaginal vault prolapse?

48. You are preparing a teaching session to your junior colleagues on the use and safety of electrosurgery in laparoscopy. You discuss the different types of currents produced by the electrosurgical unit (generator).

Which of the following describes the cutting current?

49. You see a 36-year-old woman in your gynaecology clinic. She presents with pelviabdominal mass. Ultrasound scan shows a single, large uterine fibroid. You counsel her regarding management options. She wishes to avoid surgical management and has read about UAE on the Internet.

What is the rate of hysterectomy for women undergoing UAE at 5 years?

50. You see a 35-year-old para 3 in your outpatient hysteroscopy clinic. She wants to be sterilized and undergoes hysteroscopic sterilization using the Essure device.

What post procedure advise  will you offer ?