FLS EXAM 166 QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTION
What are the laparoscope diameters? Answer - 2-10mm
Which degree scope is best for a field in line with port? Answer - 0 degree
How to prevent fogging of scope? Answer - Use anti fog solution or put scope
in hot water/hot bath
What is the most commonly used light source? Answer - 300 W Xenon lamp
What if there is initial low pressure and high flow rate at entry? Answer - Leak
in insufflator circuit, make sure everything plugged in correctly
Benefits of monopolar Answer - Tissue is heated quickly, less thermal
damage/coagulation
Monopolar voltage/frequency Answer - Low voltage/High frequency
What does coagulation mode do? Answer - Repid surface heating with shallow
depth of necrosis, intermittent wave form with higher voltage
Risk of monopolar Answer - Current can be diverted through unintentional
pathways, leading to inadvertent tissue injury. Don't use hybrid ports that mix
metal with plastic
,Why do you need a grounding pad for monopolar? Answer - Capacitative
coupling - transfer of energy between two conductors separated by an
insulator, transfer to passive electrode. Can release with tissue injury, but no
issue if ground plate is working as capacitor can't store the charge
Benefits of bipolar Answer - lower energy, producing less lateral tissue damage
and necrosis. Don't need a grounding pad
Risk of bipolar Answer - Risk of cutting patient vessels before adequate sealing,
and device doesn't work if there is metal between the jaws
Risk of ultrasonic dissection (harmonic) Answer - Active blade can injure
something due to high frequency (50mHz)
Discontinue aspirin day of surgery? Answer - No
How to enter in patient with bowel obstruction? Answer - Direct visualization
Cut vs Coag Answer - cut - heat tissue quickly to convert cell water to steam,
lysing the cell
Coag - heat more widely dispersed, less cutting action
smaller tissue area, greater current density and faster heating Answer - e.g.
Bovie tip
Cut mode Answer - - Low voltage
- High frequency
- Continuous waveform
, - Heats tissue quickly; cell water converts to steam and causes cell to explode
Coagulation mode Answer - - High voltage
- Low frequency
- Intermittent waveform
- Rapid tissue heating, shallow depth of necrosis
- Non-contact: relies on sparking to tissue
Capacitive coupling Answer - Transfer current from active electrode through
insulation to passive electrode- electrode to plastic part another LSC
instrument
- if constant contact w/ tissue will not store energy and no injury
Direct coupling Answer - monopolar instrument in direct contact w/ metal
portion of another instrument
Besides capacitative coupling and direct coupling, other hazards of
electrocautery Answer - - Current diversion
- Narrow return circuit
Bipolar Answer - - forceps w/ two twins (one active other return)
- no pt return electrode required)
- no capacitative coupling
- works in "wet" operative field
- less thermal spread compared to monopolar
bipolar seals vessels up to _____ mm in diameter Answer - 7 mm
COMPLETE SOLUTION
What are the laparoscope diameters? Answer - 2-10mm
Which degree scope is best for a field in line with port? Answer - 0 degree
How to prevent fogging of scope? Answer - Use anti fog solution or put scope
in hot water/hot bath
What is the most commonly used light source? Answer - 300 W Xenon lamp
What if there is initial low pressure and high flow rate at entry? Answer - Leak
in insufflator circuit, make sure everything plugged in correctly
Benefits of monopolar Answer - Tissue is heated quickly, less thermal
damage/coagulation
Monopolar voltage/frequency Answer - Low voltage/High frequency
What does coagulation mode do? Answer - Repid surface heating with shallow
depth of necrosis, intermittent wave form with higher voltage
Risk of monopolar Answer - Current can be diverted through unintentional
pathways, leading to inadvertent tissue injury. Don't use hybrid ports that mix
metal with plastic
,Why do you need a grounding pad for monopolar? Answer - Capacitative
coupling - transfer of energy between two conductors separated by an
insulator, transfer to passive electrode. Can release with tissue injury, but no
issue if ground plate is working as capacitor can't store the charge
Benefits of bipolar Answer - lower energy, producing less lateral tissue damage
and necrosis. Don't need a grounding pad
Risk of bipolar Answer - Risk of cutting patient vessels before adequate sealing,
and device doesn't work if there is metal between the jaws
Risk of ultrasonic dissection (harmonic) Answer - Active blade can injure
something due to high frequency (50mHz)
Discontinue aspirin day of surgery? Answer - No
How to enter in patient with bowel obstruction? Answer - Direct visualization
Cut vs Coag Answer - cut - heat tissue quickly to convert cell water to steam,
lysing the cell
Coag - heat more widely dispersed, less cutting action
smaller tissue area, greater current density and faster heating Answer - e.g.
Bovie tip
Cut mode Answer - - Low voltage
- High frequency
- Continuous waveform
, - Heats tissue quickly; cell water converts to steam and causes cell to explode
Coagulation mode Answer - - High voltage
- Low frequency
- Intermittent waveform
- Rapid tissue heating, shallow depth of necrosis
- Non-contact: relies on sparking to tissue
Capacitive coupling Answer - Transfer current from active electrode through
insulation to passive electrode- electrode to plastic part another LSC
instrument
- if constant contact w/ tissue will not store energy and no injury
Direct coupling Answer - monopolar instrument in direct contact w/ metal
portion of another instrument
Besides capacitative coupling and direct coupling, other hazards of
electrocautery Answer - - Current diversion
- Narrow return circuit
Bipolar Answer - - forceps w/ two twins (one active other return)
- no pt return electrode required)
- no capacitative coupling
- works in "wet" operative field
- less thermal spread compared to monopolar
bipolar seals vessels up to _____ mm in diameter Answer - 7 mm
