Image Based Questions PDF By PediaWale Sir

Image Based Questions PDF




GNA Nursing Academy, Jaipur Con. No. - 9829003447, 9829003449, 9784100349, 9950503447

,Question: Identify the following image showing the method of trocar insertion
during laparoscopic surgery.




(a) Veress needle (Closed technique)
(b) Hasson technique (Open technique)
(c) Optical trocar insertion
(d) Direct trocar insertion

Answer: d
Solution:
● Trocar insertion is the first and critical step in laparoscopy.
● Hasson (Open) technique: Umbilical incision → peritoneum opened under
direct vision → blunt trocar inserted → cannula fixed with sutures.
● Considered safer in patients with previous abdominal surgeries to avoid
bowel/vascular injury.
● Closed (Veress) technique: Uses a spring-loaded Veress needle to establish
pneumoperitoneum before trocar insertion.
● Optical trocar technique: Uses camera-guided trocar entry with continuous
visualization.
● Direct trocar insertion: Trocar inserted without pneumoperitoneum, done
blindly after small incision.
● The image typically shows an open approach with blunt trocar and anchoring
sutures → Hasson technique.
● OT nurses must correctly identify and prepare instruments for the chosen
method.

Dissection of Options:
● (A) Veress needle (Closed technique): Requires a Veress needle; not seen in the
image.
● (B) Hasson technique (Open technique): Correct. Incision + direct vision +
blunt trocar → matches the image.
GNA Nursing Academy, Jaipur Con. No. - 9829003447, 9829003449, 9784100349, 9950503447

,● (C) Optical trocar insertion: Needs trocar with a scope inside; not shown in the
image.
● (D) Direct trocar insertion: Blind entry after incision; not same as open method
in the image.


Question: Identify the following intra-operative image from a minimally invasive
procedure showing removal of which organ.




(a) Laparoscopic cholecystectomy
(b) Laparoscopic appendectomy
(c) Diagnostic laparoscopy
(d) Laparoscopic hernia repair

Answer: a
Solution:
● Laparoscopic cholecystectomy (Lap Chole) is the gold standard procedure for
symptomatic gallstones




GNA Nursing Academy, Jaipur Con. No. - 9829003447, 9829003449, 9784100349, 9950503447

, ● Standard access: 4 ports → 10 mm umbilical port (camera), 10 mm epigastric
port (working), 5 mm subcostal ports (assistance).
● Dissection occurs in Calot’s triangle (cystic duct, cystic artery, common hepatic
duct).
● Gallbladder is separated from liver bed and removed through umbilical port.
● Benefits: minimal incision, faster recovery, reduced infection risk.
● Differentiation from other laparoscopic procedures depends on port placement
pattern and target organ visibility in the image.
● OT nurse must anticipate correct instruments (trocar, laparoscope, clip applier,
electrocautery).

Dissection of Options:
● (A) Laparoscopic cholecystectomy Correct – 4 port technique aimed at
gallbladder removal; classic image recognition.
● (B) Laparoscopic appendectomy Usually involves 3 ports in right iliac fossa
region, not right hypochondrium.
● (C) Diagnostic laparoscopy Generally 1–2 ports used for inspection, not organ
removal.
● (D) Laparoscopic hernia repair Ports placed lower in the abdomen, near
inguinal region, not upper abdomen.




GNA Nursing Academy, Jaipur Con. No. - 9829003447, 9829003449, 9784100349, 9950503447