FLS END OF COURSE EXAM QUESTIONS AND ANSWERS
GRADED A+
✔✔which ASA class(es) are not candidates for laparoscopy and why? - ✔✔ASA classes
4 and 5 because they wont be able to tolerate the pneumoperitoneum
✔✔what adjustments do you have to make for obese patients undergoing laparoscopic
surgery? - ✔✔-use longer trocars (>100mm)
-enter perpendicular to abdominal wall
✔✔what adjustments do you have to make for thin patients undergoing laparoscopic
surgery? - ✔✔-markedly elevate abdominal wall
-place verees needle away from midline near costal margin
-use visiport
✔✔absolute contraindications laparoscopic surgery - ✔✔-inability to tolerate laparotomy
-hypovolemic shock
-lack of proper surgeon training/experience
-lack of instrument support
✔✔relative contraindications laparoscopic surgery - ✔✔-inability to tolerate general
anesthesia
-long standing peritonitis (may increase risk of injury during trocar placement)
-large abdominal vs pelvic mass
-massive incarcerated ventral or inguinal hernia
-severe cardiopulmonary disease (making them intolerant of positioning)
✔✔other potential contraindications laparoscopic surgery - ✔✔-visceral arterial
aneurysm
-scar from previous surgery that can impede entry (adhesions)
-h/o peritonitis: increased risk of adhesions or enterotomy
-umbilical abnormalities
-ventral hernia (size of prosthetic can be much larger than the visualized scars
-hepatic cirrhosis: increased risk of hemorrhage and postop ascites leakage
-intestinal obstructions: increase risk of enterotomy and limited visualization
-pregnancy
✔✔contraindications to laparoscopic cholecystectomy - ✔✔-gallbladder cancer
-portal hypertension
-cirrhosis
-acute cholecystitis
-mirizzi syndrome (common hepatic duct obstruction caused by extrinsic compression
from an impacted stone in the cystic duct or infundibulum of the gallbladder; p/w
jaundice, fever, RUQ pain)
, ✔✔contraindications to laparoscopic appendectomy - ✔✔-phlegmon
-large abscess
✔✔contraindications to laparoscopic colon resection - ✔✔-large fixed mass
-dense pelvic adhesions
-massive bowel dilation
-T4 tumor
✔✔contraindications to emergency laparoscopy - ✔✔-longstanding peritonitis
-hemodynaic instability
-massive bowel dilation
✔✔contraindications to pelvic laparoscopiy - ✔✔large fixed mass, inability to tolerate
trendelenberg
✔✔contraindications to laparoscopic foregut procedures - ✔✔-previous gastric
operations especially at the GE junction
-hepatosplenomegaly
✔✔contraindications to laparoscopic anti-relux surgery - ✔✔-esophageal shortening
-epithelial dysplasia
- previous gastric surgery at GE junction
-liver enlargement
-large hiatal hernia
✔✔contraindication to laparoscopic hernia repair - ✔✔-large chronically incarcerated
hernias
-acute incarcerated hernias requiring bowel resection
-need for removal of large prosthetics
-need for skin graft removal or large scar revision
✔✔conditions commonly mistaken for contraindications for laparoscopic surgery - ✔✔-
diaphragm injury
-GI bleed
-perforated viscus
-bowel obstruction
-abdominal trauma
-intrauterine ectopic pregnancy
-obesity
-COPD
-renal insufficiency
✔✔best way to identify transition point in SBO laparoscopically - ✔✔manipulate distal
decompressed bowel and work your way upwards to avoid damaging the dilated loops
GRADED A+
✔✔which ASA class(es) are not candidates for laparoscopy and why? - ✔✔ASA classes
4 and 5 because they wont be able to tolerate the pneumoperitoneum
✔✔what adjustments do you have to make for obese patients undergoing laparoscopic
surgery? - ✔✔-use longer trocars (>100mm)
-enter perpendicular to abdominal wall
✔✔what adjustments do you have to make for thin patients undergoing laparoscopic
surgery? - ✔✔-markedly elevate abdominal wall
-place verees needle away from midline near costal margin
-use visiport
✔✔absolute contraindications laparoscopic surgery - ✔✔-inability to tolerate laparotomy
-hypovolemic shock
-lack of proper surgeon training/experience
-lack of instrument support
✔✔relative contraindications laparoscopic surgery - ✔✔-inability to tolerate general
anesthesia
-long standing peritonitis (may increase risk of injury during trocar placement)
-large abdominal vs pelvic mass
-massive incarcerated ventral or inguinal hernia
-severe cardiopulmonary disease (making them intolerant of positioning)
✔✔other potential contraindications laparoscopic surgery - ✔✔-visceral arterial
aneurysm
-scar from previous surgery that can impede entry (adhesions)
-h/o peritonitis: increased risk of adhesions or enterotomy
-umbilical abnormalities
-ventral hernia (size of prosthetic can be much larger than the visualized scars
-hepatic cirrhosis: increased risk of hemorrhage and postop ascites leakage
-intestinal obstructions: increase risk of enterotomy and limited visualization
-pregnancy
✔✔contraindications to laparoscopic cholecystectomy - ✔✔-gallbladder cancer
-portal hypertension
-cirrhosis
-acute cholecystitis
-mirizzi syndrome (common hepatic duct obstruction caused by extrinsic compression
from an impacted stone in the cystic duct or infundibulum of the gallbladder; p/w
jaundice, fever, RUQ pain)
, ✔✔contraindications to laparoscopic appendectomy - ✔✔-phlegmon
-large abscess
✔✔contraindications to laparoscopic colon resection - ✔✔-large fixed mass
-dense pelvic adhesions
-massive bowel dilation
-T4 tumor
✔✔contraindications to emergency laparoscopy - ✔✔-longstanding peritonitis
-hemodynaic instability
-massive bowel dilation
✔✔contraindications to pelvic laparoscopiy - ✔✔large fixed mass, inability to tolerate
trendelenberg
✔✔contraindications to laparoscopic foregut procedures - ✔✔-previous gastric
operations especially at the GE junction
-hepatosplenomegaly
✔✔contraindications to laparoscopic anti-relux surgery - ✔✔-esophageal shortening
-epithelial dysplasia
- previous gastric surgery at GE junction
-liver enlargement
-large hiatal hernia
✔✔contraindication to laparoscopic hernia repair - ✔✔-large chronically incarcerated
hernias
-acute incarcerated hernias requiring bowel resection
-need for removal of large prosthetics
-need for skin graft removal or large scar revision
✔✔conditions commonly mistaken for contraindications for laparoscopic surgery - ✔✔-
diaphragm injury
-GI bleed
-perforated viscus
-bowel obstruction
-abdominal trauma
-intrauterine ectopic pregnancy
-obesity
-COPD
-renal insufficiency
✔✔best way to identify transition point in SBO laparoscopically - ✔✔manipulate distal
decompressed bowel and work your way upwards to avoid damaging the dilated loops
