Core Surgical Skills

Question 1

What is the overall rate of serious complications at gynaecological laparoscopy?

Answer 1

1 in 1,000 cases

Question 2

Which complications must be explained for every woman having a gynaecolgical laparoscopy?

Answer 2

Damage to bladder, bowel and urinary tract, and incisional hernia

Question 3

What is the evidence for open (Hasson’s) versus closed (Veress/Visiport) laparoscopic entry?

Answer 3

No significant safety advantage to either method on meta-analysis

Question 4

What two points of technique are evidenced to improve successful Veress needle entry?

Answer 4

1. Not elevating the abdominal wall
2. Observe that the initial insufflation pressure is <8mmHg

Question 5

What intra-abdominal pressures should be used during and after laparoscopic entry?

Answer 5

1. Entry pressure of 20-25mmHg
2. Operating pressure of 12-15mmHg

Question 6

Where is Palmer’s point?

Answer 6

3cm below the left costal margin in the mid-clavicular line

Question 7

What are the rules for the deep rectus sheath should be closed at a port site?

Answer 7

1. Any non-midline port over 7mm should be closed
2. Any midline port over 10mm should be closed

Question 8

Why may saline be a better distension medium than CO2 at outpatient hysteroscopy?

Answer 8

1. It is associated with fewer cases of vasovagal syncope
2. Image quality is often better than with CO2
3. Saline is required if using bipolar electrosurgery

Question 9

What analgesia should be provided if grasping the cervix with a tenaculum is necessary at outpatient hysteroscopy?

Answer 9

Topical local anaesthetic

Question 10

What is the evidence for cervical preparation with prostaglandins prior to outpatient hysteroscopy?

Answer 10

1. No reduction in rate of cervical lacerations across a meta-analysis
2. No reduction in failure rates across a meta-analysis
3. Less pain during cervical dilatation for post-menopausal women who received Misoprostol prior to OPH