FLS MODULE 3 BASIC LAPAROSCOPIC
PROCEDURES CERTIFICATION EVALUATION
2026 QUESTIONS WITH PRACTICE SOLUTION
GRADED A+
◉ Complications of pneumo/initial trocar placement? Answer: -
bowel injury
-mesenteric injury
-omental injury
-retroperitoneal injury
-cardiac arrhythmia
-hypotension
-high airway pressures
-pneumothorax
-gas embolism
◉ Why is CO2 the preferred gas to establish pneumoperitoneum?
Answer: -rapidly absorbed
-easily eliminated
-suppresses combustion
-readily available
,-inexpensive
◉ Chemical effects of CO2? Answer: -increases arterial CO2
concentration
-increased end-tidal CO2
-decrease serum pH
◉ Physiologic impact of these chemical effects? Answer: -increased
minute ventilation
-reduced FRC
-increased peak airway pressure
-reduced pulmonary compliance
◉ Benefits of nitrous oxide vs. CO2? Answer: -less acid-base
disturbances
-tolerated better with severe cardio-pulmonary disease
-slightly less postoperative pain
◉ Major risk of using nitrous oxide? Answer: -fire hazard if using
electrocautery in the presence of open bowel (supports combustion)
◉ Downsides of using Argon and Helium? Answer: -increased risk of
gas embolus
,-more expensive
◉ Impact of CO2 on cardiac output? Answer: -decreased
◉ Why does this occur? Answer: -due to both chemical and pressure
effects
◉ Decrease in CO2 is exacerbated by...? Answer: -reverse
trendeleberg
-hypovolemia
◉ Next steps if there are signs that pneumoperitoneum is decreasing
cardiac output? Answer: -desufflate immmediately
-check insufflator settings
-check for adequate relaxation
-check intravascular volume status
-check for other causes of hypotension
◉ What cardiac arrhythmias can be caused by pneumoperitoneum?
Answer: -sinus tachycardia
-PVCs
-bradycardia
, ◉ Symptoms of gas embolus? Answer: -severe hypotension
-JVD
-tachycardia
-mill wheel murmur
◉ Next steps in management of gas embolus? Answer: -trendeleberg
-L lateral decubitus
-rapid fluid administration
-central line to right heart chamber
◉ What is the most common dysrhythmia during
pneumoperitoneum? Answer: -bradycardia
◉ Most common causes of unrecognized bleeding at the end of
cases? Answer: -trocar injury of abdominal wall vessels
-injury to vessels or organs away from the operative field
-tamponade of venous bleeding
◉ Where should ports be placed to access the kidney and adrenal
glands? Answer: -along the costal margin
◉ What is the gauge of needles used to perform FNA? Answer: -20-
22 gauge
PROCEDURES CERTIFICATION EVALUATION
2026 QUESTIONS WITH PRACTICE SOLUTION
GRADED A+
◉ Complications of pneumo/initial trocar placement? Answer: -
bowel injury
-mesenteric injury
-omental injury
-retroperitoneal injury
-cardiac arrhythmia
-hypotension
-high airway pressures
-pneumothorax
-gas embolism
◉ Why is CO2 the preferred gas to establish pneumoperitoneum?
Answer: -rapidly absorbed
-easily eliminated
-suppresses combustion
-readily available
,-inexpensive
◉ Chemical effects of CO2? Answer: -increases arterial CO2
concentration
-increased end-tidal CO2
-decrease serum pH
◉ Physiologic impact of these chemical effects? Answer: -increased
minute ventilation
-reduced FRC
-increased peak airway pressure
-reduced pulmonary compliance
◉ Benefits of nitrous oxide vs. CO2? Answer: -less acid-base
disturbances
-tolerated better with severe cardio-pulmonary disease
-slightly less postoperative pain
◉ Major risk of using nitrous oxide? Answer: -fire hazard if using
electrocautery in the presence of open bowel (supports combustion)
◉ Downsides of using Argon and Helium? Answer: -increased risk of
gas embolus
,-more expensive
◉ Impact of CO2 on cardiac output? Answer: -decreased
◉ Why does this occur? Answer: -due to both chemical and pressure
effects
◉ Decrease in CO2 is exacerbated by...? Answer: -reverse
trendeleberg
-hypovolemia
◉ Next steps if there are signs that pneumoperitoneum is decreasing
cardiac output? Answer: -desufflate immmediately
-check insufflator settings
-check for adequate relaxation
-check intravascular volume status
-check for other causes of hypotension
◉ What cardiac arrhythmias can be caused by pneumoperitoneum?
Answer: -sinus tachycardia
-PVCs
-bradycardia
, ◉ Symptoms of gas embolus? Answer: -severe hypotension
-JVD
-tachycardia
-mill wheel murmur
◉ Next steps in management of gas embolus? Answer: -trendeleberg
-L lateral decubitus
-rapid fluid administration
-central line to right heart chamber
◉ What is the most common dysrhythmia during
pneumoperitoneum? Answer: -bradycardia
◉ Most common causes of unrecognized bleeding at the end of
cases? Answer: -trocar injury of abdominal wall vessels
-injury to vessels or organs away from the operative field
-tamponade of venous bleeding
◉ Where should ports be placed to access the kidney and adrenal
glands? Answer: -along the costal margin
◉ What is the gauge of needles used to perform FNA? Answer: -20-
22 gauge
