FLS UPDATED EXAM SCRIPT QUESTIONS AND ANSWERS
GRADED A+
✔✔ASA classes that may not be appropriate for LSC sx - ✔✔ASA 4 and 5
- body cannot handle decreased venous return, need for hyperventilation
✔✔Length of trocar needed for obese pt - ✔✔>100 mm
✔✔ABSOLUTE C/I to LSC - ✔✔- Inability to tolerate laparotomy
- Hypovolemic shock
- Lack proper surgeon training/experience
- Lack appropriate institutional support
✔✔Relative C/I to LSC - ✔✔- Inability to tolerate GETA
- Long-standing peritonitis
- Large abd/pelvic mass
- Massive incarcerated ventral and inguinal hernias
- Severe cardiopulmonary dz
✔✔NOT C/I to LSC - ✔✔- Diaphragm injury
- GI bleed
- Performed viscus
- Bowel obstruction
- Abd trauma if HD stable
- COPD
- Renal insufficiency
✔✔Preop precautions - ✔✔Be aware of
- Visceral arterial aneurysm (risk injury w/ trocar insertion)
- prior ventral hernia repair w/ mesh (NO blind entry w/ veress or trocar through mesh!)
- H/o peritonitis (risk adhesions and enterotomy)
- Cirrhosis (increased risk of bleeding and ascites leak through ports/wounds)
- Intestinal obstruction
✔✔GETA pre-meds - ✔✔BZ, atropine/glycopyrrolate (prevent bradyarrhythmia from
pneumoperitoneum), H2 blocker
✔✔CO2 benefits - ✔✔- Rapidly absorbed
- Easily eliminated (diffusion coefficient 20x CO2)
- Suppresses combustion
- Readily available
- Inexpensive
✔✔Chemical effects of CO2 - ✔✔- Increase arterial and end tidal CO2
- Decrease serum pH w/ greatest change in first 20 min (SS after 1h)
, ✔✔Pressure effects of CO2 - ✔✔Pulm
- Reduced functional residual capacity
- Reduced pulmonary compliance
- Increased peak airway pressure
CV
- Increase preload and afterload, DECREASE CO
- Brady, PVC
- increased VC resistance and decrease venous flow, theoretically increase risk VTE
Renal
- intraop oliguria d/t increased intraabd pressure, decreased renal BF
✔✔Shortly after insufflation pt becomes hypotensive, bradycardic w/ decreased UOP,
what to do? - ✔✔Experiencing vagally-induced bradycardia
- STOP, desufflate immediately
- check adequate relaxation
- check intravascular volume status
- check other causes of hypotension (e.g. bleeding)
- once stabilized and r/o other causes, reinsufflate slower and w/ lower pressure
✔✔During the case pt suddenly becomes hypotensive, tachycardic. You note JV
distention and audible mill wheel murmur on cardiac auscultation. What to do? - ✔✔CV
collapse from gas embolism!
- place pt in trendelenberg position, left-side down
- rapid IVF
- central line placement to back up embolus in right heart chambers
✔✔LSC examination of small bowel - ✔✔place monitors- one near head (ligament
treitz), one near feet (ileocecal valve
place ports along left abd
IN SBO pt, start at ILEOCECAL valve (most distal, should be most decompressed)
✔✔FNA uses ______G needle - ✔✔20-22 G
✔✔Core biopsy uses a _____G needle - ✔✔14-16 G
✔✔LSC suturing technique - ✔✔- ports at least 10 cm apart to allow intracorporeal knot
tying
- 10-12 mm trocar accommodates standard SH needle
✔✔Length of suture for intracorporeal knot tying - ✔✔6 inches (15 cm)
✔✔Length of suture for extracorporeal knot tying - ✔✔30 inches (76 cm)
✔✔2-2.5 mm staples used for - ✔✔- white/grey in color
GRADED A+
✔✔ASA classes that may not be appropriate for LSC sx - ✔✔ASA 4 and 5
- body cannot handle decreased venous return, need for hyperventilation
✔✔Length of trocar needed for obese pt - ✔✔>100 mm
✔✔ABSOLUTE C/I to LSC - ✔✔- Inability to tolerate laparotomy
- Hypovolemic shock
- Lack proper surgeon training/experience
- Lack appropriate institutional support
✔✔Relative C/I to LSC - ✔✔- Inability to tolerate GETA
- Long-standing peritonitis
- Large abd/pelvic mass
- Massive incarcerated ventral and inguinal hernias
- Severe cardiopulmonary dz
✔✔NOT C/I to LSC - ✔✔- Diaphragm injury
- GI bleed
- Performed viscus
- Bowel obstruction
- Abd trauma if HD stable
- COPD
- Renal insufficiency
✔✔Preop precautions - ✔✔Be aware of
- Visceral arterial aneurysm (risk injury w/ trocar insertion)
- prior ventral hernia repair w/ mesh (NO blind entry w/ veress or trocar through mesh!)
- H/o peritonitis (risk adhesions and enterotomy)
- Cirrhosis (increased risk of bleeding and ascites leak through ports/wounds)
- Intestinal obstruction
✔✔GETA pre-meds - ✔✔BZ, atropine/glycopyrrolate (prevent bradyarrhythmia from
pneumoperitoneum), H2 blocker
✔✔CO2 benefits - ✔✔- Rapidly absorbed
- Easily eliminated (diffusion coefficient 20x CO2)
- Suppresses combustion
- Readily available
- Inexpensive
✔✔Chemical effects of CO2 - ✔✔- Increase arterial and end tidal CO2
- Decrease serum pH w/ greatest change in first 20 min (SS after 1h)
, ✔✔Pressure effects of CO2 - ✔✔Pulm
- Reduced functional residual capacity
- Reduced pulmonary compliance
- Increased peak airway pressure
CV
- Increase preload and afterload, DECREASE CO
- Brady, PVC
- increased VC resistance and decrease venous flow, theoretically increase risk VTE
Renal
- intraop oliguria d/t increased intraabd pressure, decreased renal BF
✔✔Shortly after insufflation pt becomes hypotensive, bradycardic w/ decreased UOP,
what to do? - ✔✔Experiencing vagally-induced bradycardia
- STOP, desufflate immediately
- check adequate relaxation
- check intravascular volume status
- check other causes of hypotension (e.g. bleeding)
- once stabilized and r/o other causes, reinsufflate slower and w/ lower pressure
✔✔During the case pt suddenly becomes hypotensive, tachycardic. You note JV
distention and audible mill wheel murmur on cardiac auscultation. What to do? - ✔✔CV
collapse from gas embolism!
- place pt in trendelenberg position, left-side down
- rapid IVF
- central line placement to back up embolus in right heart chambers
✔✔LSC examination of small bowel - ✔✔place monitors- one near head (ligament
treitz), one near feet (ileocecal valve
place ports along left abd
IN SBO pt, start at ILEOCECAL valve (most distal, should be most decompressed)
✔✔FNA uses ______G needle - ✔✔20-22 G
✔✔Core biopsy uses a _____G needle - ✔✔14-16 G
✔✔LSC suturing technique - ✔✔- ports at least 10 cm apart to allow intracorporeal knot
tying
- 10-12 mm trocar accommodates standard SH needle
✔✔Length of suture for intracorporeal knot tying - ✔✔6 inches (15 cm)
✔✔Length of suture for extracorporeal knot tying - ✔✔30 inches (76 cm)
✔✔2-2.5 mm staples used for - ✔✔- white/grey in color
