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