Avoiding Complications in Gynaecological minimal access surgery – Multiple Choice Questions for Vol. 35




.



  • 1.

    What is the overall complication rate for gynaecologic laparoscopic surgery?



    • a)

      0.6%


    • b)

      1.2%


    • c)

      1.6%


    • d)

      2%


    • e)

      2.4%



  • 2.

    What is the average distance between Palmer’s point and the aorta?



    • a)

      6 cm


    • b)

      8 cm


    • c)

      10 cm


    • d)

      12 cm


    • e)

      14 cm



  • 3.

    What is the most effective test described to verify correct Veress needle intraperitoneal placement?



    • a)

      Initial gas pressures less than 10 mmHg


    • b)

      Double click


    • c)

      Two or more passes of the Veress needle


    • d)

      Hanging drop test


    • e)

      A “free” feel to the end of the Veress needle



  • 4.

    Laparoscopy can be used to perform which of the following Gyn-Oncology Surgeries?



    • a)

      Pelvic Lymphadenectomy


    • b)

      Para-aortic Lymphadenectomy


    • c)

      Inguinal Lymphadenectomy


    • d)

      Radical Hysterectomy


    • e)

      Radical Trachelectomy



  • 5.

    Laparoscopy has similar complication rates when compared to open surgery for which of the following parameters?



    • a)

      Ureteric Injury


    • b)

      Bladder Injury


    • c)

      Bowel Injury


    • d)

      Nerve Injury


    • e)

      Blood loss



  • 6.

    Laparoscopy is likely to benefit from which of the following technical advances?



    • a)

      3D-Vision systems


    • b)

      4K-Vision systems


    • c)

      Slow Motion Replay Option


    • d)

      Advanced Harmonic Energy Sources


    • e)

      Smoke-Evacuation



  • 7.

    Typical complications of radical laparoscopic hysterectomy include which of the following?



    • a)

      Atonic bladder


    • b)

      Ureterovaginal Fistula


    • c)

      Pelvic Lymphocele


    • d)

      Rectal Atony


    • e)

      Compartment Syndrome



  • 8.

    Which of the following statements about surgical preoperative planning in patients with severe endometriosis with possible bowel involvement is/are true?



    • a)

      In patients where periumbilical adhesions are suspected, it is better to use the Veress needle to achieve pneumoperitoneum in order to minimize entry complications.


    • b)

      When an intestinal opening is observed the surgeon should perform the suture side-to-side.


    • c)

      Mechanical bowel preparation to all patients preoperatively decreases complications in segmental resection.


    • d)

      The occurrence of pseudomembranous colitis is an adverse effect related to the use of surgical prophylactic antibiotics


    • e)

      Prophylactic antibiotic use in colorectal surgery reduces surgical site infections



  • 9.

    Which of the following is/are true about bowel resection techniques?



    • a)

      The shaving technique should be performed in patients who do not wish to become pregnant, since pregnancy rates are lower compared to alternative techniques.


    • b)

      Double circular stapler technique (DCS) allows lesions up to 5 cm to be excised and is associated with less complications compared with segmental resection.


    • c)

      Anastomosis tension is a risk factor for dehiscence and mobilization of the splenic flexure may be necessary to minimize it.


    • d)

      Use of small diameter circular staplers is preferred for intestinal anastomosis after segmental resection.


    • e)

      Segmental bowel resection has the same complication rates as conservative surgical procedures.



  • 10.

    Which of the following is/are true about bowel endometriosis surgery?



    • a)

      The use of drains should be encouraged postoperatively as it can detect anastomosis leakage at an earlier stage.


    • b)

      There is no reliable method to evaluate intraoperative bowel anastomosis integrity.


    • c)

      In patients with bowel endometriosis lesions lower than 5 cm from the anal verge intestinal diversion is recommended after segmental resection.


    • d)

      A colostomy should be preferred over ileostomy when intestinal diversion is needed because it is associated with less complications.


    • e)

      In long procedures with the need for blood transfusion, the risk of anastomotic dehiscence increases.



  • 11.

    Which of the following statements about the postoperative period after bowel resection is/are true?



    • a)

      Oxygen supplementation should be used routinely after surgery.


    • b)

      Excessive hydration in the perioperative period is potentially associated with anastomosis complications.


    • c)

      Imaging tests have excellent performance for early diagnosis of intestinal dehiscence.


    • d)

      The use of C-reactive protein in the postoperative period may be useful for early detection of complications.


    • e)

      The adoption of fast track protocols after surgery reduces the length of hospital stay and morbidity.



  • 12.

    Which of the following is/are true in relation to medical worldwide health costs?



    • a)

      The expenditure for health care in Switzerland rose from 8.8 % of gross domestic product (GDP) in 1995 up to 10.9 % of the GPD in 2013.


    • b)

      In the USA, the mean in-hospital cost of all patients without complications was US$10000.


    • c)

      The occurrence of a Clavien-Dindo grade I complications creates significant additional costs of US$2793


    • d)

      Costs for health care in Switzerland in 2013 were about US$10 billion


    • e)

      10 percent of Switzerland’s total health care costs were generated by surgical departments.



  • 13.

    Results from the Norwegian Gynaecologic Endoscopic Register indicate which of the following?



    • a)

      The average intraoperative complication rate for hysteroscopy is 3.7%


    • b)

      The average intraoperative complication rate for laparoscopy is 2.8%


    • c)

      The highest incidence of postoperative complication is haemorrhage.


    • d)

      Diabetes Mellitus is shown to be a risk factor for postoperative detected organ damage.


    • e)

      Intraoperative complications significantly increase the incidence of postoperative complications.



  • 14.

    Further results from the Norwegian Gynaecologic Endoscopic Register regarding intraoperative complications include which of the following?



    • a)

      The most common complication is intraabdominal bowel injury.


    • b)

      The second most common complication is bladder injury (0.17%).


    • c)

      The most common intraoperative hysteroscopic complication is perforation of the uterus (1.79%).


    • d)

      The second most common postoperative hysteroscopic complication is organ damage.


    • e)

      The incidence of infection post-hysteroscopy is < 2%



  • 15.

    The following is/are true regarding Operative Registers?



    • a)

      There is a role for Operative Registers to survey complications


    • b)

      There is a role for Operative Registers to survey patient health care


    • c)

      Experiences from the NGER can be transferred during the establishment of other regional registers.


    • d)

      Obesity is a contraindication to laparoscopy as found in the register


    • e)

      Complications caused by equipment was a common incident found in the register



  • 16.

    The recent classification of the Federation International of Gynecology and Obstetrics (FIGO) identified types of fibroids as they are defined in terms of:



    • a)

      Their relationship with the cervix


    • b)

      Their relationship with each other


    • c)

      Their size


    • d)

      Their relationship with the endometrium


    • e)

      Their relationship with the uterine serosa



  • 17.

    VizAblate System ® is a new device for the treatment of symptomatic myomas which allows which of the following?



    • a)

      Removal of myomas under direct hysteroscopic visualization


    • b)

      Transcervical fibroid thermal ablation


    • c)

      Imaging under real-time sonography


    • d)

      Laparoscopic fibroid thermal ablation under laparoscopic ultrasound


    • e)

      Fibroid morcellation during operative hysteroscopy



  • 18.

    Barbed suture is a monofilament suture with tiny barbs cut into the length of the suture. In comparison to a conventional suture it has which of the following?



    • a)

      It maintains tension of the suture line during suturing


    • b)

      It facilitates laparoscopic suturing


    • c)

      It reduces blood loss during myomectomy


    • d)

      It approximates the tissue without the need for a surgical knot


    • e)

      It is absorbable in 10 days



  • 19.

    Morcellated surgical specimens can be removed via which of the following?



    • a)

      Vagina


    • b)

      Posterior Cul-de-sac


    • c)

      Mini-laparotomy


    • d)

      Cervix


    • e)

      Trans-rectal



  • 20.

    According to recommendations by the FDA, laparoscopic morcellation should be contraindicated in which of the following?



    • a)

      Peri-menopausal women


    • b)

      Post-menopausal women


    • c)

      Young women with fibroids greater than 6 cm


    • d)

      Women with fibroids suspicious for malignancy


    • e)

      Women with specimens that are candidates for en-bloc removal



  • 21.

    According to data collected by the MAUDE and MDR databases, the most common location of morcellation injuries is which of the following?



    • a)

      Bowel


    • b)

      Vascular


    • c)

      Bladder


    • d)

      Abdominal wall


    • e)

      Ureter



  • 22.

    Which of the following statements best describes resident attitudes when they finish their obstetrics and gynecology training program?



    • a)

      They are generally confident in performing all complex minimally invasive surgery


    • b)

      They have an opportunity to perform more surgeries than their predecessors


    • c)

      They have decreased work hours to learn the required materials


    • d)

      They are uniformly accessing standardized simulation curricula to hone their skills.


    • e)

      They do not consider further training to become more proficient surgeons.



  • 23.

    Which of the following statements best describes the role of surgical simulation in learning laparoscopic surgery?



    • a)

      Simulation shortens learning curves without compromising patient care.


    • b)

      We cannot justify the cost of simulation equipment for resident training.


    • c)

      Simulation replaces learning in the operating room


    • d)

      There are no simulators involving complex technology.


    • e)

      There is only one model available for simulation of gynaecologic minimally invasive surgery.



  • 24.

    Why is intra-operative surgical skill acquisition compromised in an informal experiential learning environment?



    • a)

      Faculty infrequently spend time identifying the learning needs of the trainee


    • b)

      There is rarely the opportunity for post-operative debriefing


    • c)

      There is lack of feedback to the learner


    • d)

      There is minimal use of validated assessment tools


    • e)

      There is a lack of training for the trainers



  • 25.

    Which of the following is/are principal advantages of using a generic error rating tool as feedback to surgeons?



    • a)

      It is an interactive intraoperative feedback tool


    • b)

      It provides a global rating of surgical performance


    • c)

      Every technical error can be analyzed and it offers a precise tool for formative feedback


    • d)

      It identifies only the errors that will lead to complications.


    • e)

      It is quick to utilize in providing feedback.



  • 26.

    Concerning validation of a robotic simulator:



    • a)

      Face validity examines how closely the simulator resembles the real task


    • b)

      Construct validity measures the relationship with future performance


    • c)

      Predictive validity applies to a simulator that is able to differentiate between novices and experts


    • d)

      Usefulness of tasks and movement realism can be assessed by content validation


    • e)

      Content validity examines if the intended content domain is actually being measured



  • 27.

    Concerning Robotic Simulators:



    • a)

      The da Vinci Skills Surgical Simulator (dVSS) is the only simulator that utilizes the same console that is used for actual operating procedures.


    • b)

      The RoSS simulator has demonstrated face, content, and construct validity


    • c)

      The RoSS simulator uses virtual reality


    • d)

      The RoSS simulator simulates an actual surgical experience from beginner to advanced


    • e)

      The Mimic dV-Trainer requires an existing surgical console for utilizing all its applications



  • 28.

    Which of the following statements regarding mentoring and proctoring is true?



    • a)

      In proctoring, a master educates and guides a trainee surgeon with the goal of improving the trainee’s skills


    • b)

      Proctoring can lead to credentialing


    • c)

      The mentoring console (dual console) developed by Intuitive Surgical allows for both surgeons to control the same robot simultaneously


    • d)

      The “swap mode” of the mentoring console allows both mentor and trainee the same robotic arm in tandem


    • e)

      When using the “nudge mode” of the mentoring console, the trainee can feel the movements of the mentor surgeon at the second console



  • 29.

    Regarding Robotic Curriculum Training:



    • a)

      There is no standardized training program for robotic surgeons


    • b)

      The Fundamentals of Robotic Surgery (FRS) course is specifically designed for use on the RoSS simulator


    • c)

      The BSTC is not simulator-specific


    • d)

      Studies have indicated that both Obstetrics and Gynecology residents and program directors feel that there is a lack of training and structure in robotic surgery


    • e)

      The European Association of Urology course includes an OR module training as a bedside assistant and console surgeon



  • 30.

    The following statement(s) about complications in laparoscopic supracervical hysterectomy is/are true:



    • a)

      Bladder lesions may occur and the risk is higher in patients with prior Caesarean section.


    • b)

      The rate of recurrent cervical bleeding after LASH does not depend on the length of the cervical stump and the experience of the surgeon.


    • c)

      Fascial closure is recommend in trocar sizes > 20 mm in order to avoid hernia.


    • d)

      Disseminated fragments of benign endometrial tissue cannot cause peritoneal endometrial carcinoma years after LASH.


    • e)

      Ureteral injuries are not correlated with higher postsurgical morbidity as most of the lesions are detected during surgery and can be treated immediately.



Only gold members can continue reading. Log In or Register to continue

Nov 6, 2017 | Posted by in OBSTETRICS | Comments Off on Avoiding Complications in Gynaecological minimal access surgery – Multiple Choice Questions for Vol. 35
Premium Wordpress Themes by UFO Themes