3: INSTRUMENTATION

Question 1

Cystoscope degrees

Answer 1

0, 30, 70

Question 2

Cystoscope 0 deg visualization

Answer 2

Urethral visualization

Question 3

Cystoscope 30 deg visualization

Answer 3

Bladder base and posterior wall

Question 4

Cystoscope 70 deg visualization

Answer 4

Anterior and lateral walls
Can do a full systematic bladder survey with this scope

Question 5

Size of flexible hysteroscopes

Answer 5

2.7-5mm

Question 6

Degrees of flexible hysteroscopes

Answer 6

100-180deg

Question 7

Experience of flexible hysteroscope

Answer 7

Lower resolution, increased patient comfort (used outpatient)

Question 8

Size of rigid hysteroscopes

Answer 8

1-5mm

Question 9

Degrees of rigid hysteroscopes

Answer 9

0, 12, 15, 30, 70

Question 10

Degree hysteroscope for operative scope

Answer 10

0 degrees

Question 11

Degree hysteroscope for visualization of A/P and cornual ostia

Answer 11

30 degree

Question 12

Size of operative scope

Answer 12

8-10mm

Question 13

Size of LSC ports

Answer 13

3, 5, 8, 10, 12mm

Question 14

Relationship between LSC port size and brightness

Answer 14

Larger diameter= Brighter

Question 15

Degrees of laparoscope

Answer 15

0, 30 degrees

Question 16

Total field view of 0 degree laparoscope

Answer 16

76 degrees

Question 17

Total field view of 30 degree laparosope

Answer 17

152 degrees

Question 18

Examples of oxidizing gasses

Answer 18

O2, NO (gasses that accelerate the burning process)

Question 19

Direct coupling

Answer 19

Active electrode comes in contact with a metal object

Question 20

Capacitative coupling

Answer 20

When stray current affects non-targeted tissue

Question 21

Fire risk assessment tool values

Answer 21

0-1: Low risk for surgical fire
2: Intermediate risk for surgical fire
>/=3: High risk for surgical fire

Question 22

Scoring for fire risk assessment tool

Answer 22

Procedure is performed above xyphoid
Open O2 source (ex: ET tube w/ O2)
Prep with alcohol base
Ignition source present

Question 23

Optimal time for HSC

Answer 23

Early proliferative phase (thin lining, ensures not pregnant)

Question 24

Benefits of CO2 as gas

Answer 24

Low-cost
Non-flammable
Chemically stable
Colorless
High diffusion capacity (therefore rapid absorption through peritoneum and then direct delivery to lungs - CO2 is then excreted through respiratory exchange)

Question 25

Risks of CO2

Answer 25

Hypercapnia (if excessive absorption) - therefore acidosis (can avoid with excessive ventilation intraoperatively) Acidosis Cardiopulmonary complications (ex: tachycardia, arrhythmia, pulmonary edema) Peritoneal irritation

Question 26

Mechanisms of fluid absorption (hysteroscopy)

Answer 26

Primary: Surgical disruption of venous sinuses (more prevalent in operative HSC) Secondary: High intrauterine pressure (can result in intraperitoneal extravasation 2/2 fluid through the fallopian tubes)

Question 27

Ideal pressure HSC

Answer 27

Less than MAP (or <75mmHg) - This reduces spillage intraperitoneally through fallopian tubes MAP= D + (1/3) (systolic-diastolic)

Question 28

Preoperative meds for HSC

Answer 28

GnRH Agonist Intracervical vasopressin

Question 29

Dose of intracervical vasopressin

Answer 29

<0.4U/mL to minimize risks

Question 30

Risks of intracervical vasopressin

Answer 30

Cardiac collapse, MI, death

Question 31

Distention media for monopolar energy

Answer 31

Requires non-electrolyte containing media (ex: glycine, sorbitol)

Question 32

Distention media for bipolar energy

Answer 32

Electrolyte-containing media (ex: NS)

Question 33

Which type of fluid is conductive?

Answer 33

Eletrolyte-containing (therefore energy can be conducted through entirety of endometrial cavity)