Core Surgical Skills Flashcards
Incidence of ilioinguinal/iliohypogastric neuropathy following Pfannenstiel incision?
3.7%
Diagnostic Triad:
1. Sharp burning pain radiating from incision site to Mons pubis, labia and thigh.
2. Paraesthesia over the nerve distribution areas.
3. Pain relief following administration of LA
Injury to upper 3rd of Ureter - management?
Uretero-ureterostomy
End to end re anastomosis of the ureter
Injury to middle 3rd of Ureter - management?
Either:
1. Uretero-ureterosotomy (end to end anastomosis)
2.Trans-uretero-ureterostomy (end to end anastomosis of the injured ureter with the contralateral healthy ureter)
Injury to lower 3rd of ureter - management?
Uretero-neocystostomy
Re implantation of the ureter into the bladder.
What nerve could have been injured following SSF that presents with buttock pain?
Pudendal Nerve
What is the main artery that is responsible for the blood supply to the perineum?
Internal Pudendal Artery
Internal Pudendal Artery:
1. Branch of?
2. Course
3. Clinical significance
4. Supplies
- Branch of internal iliac artery
- Moves inferiorly and exits the pelvis via the greater sciatic foramen. Accompanied by the pudendal nerve it enters the perineum via the lesser sciatic foramen.
- Can be damaged in childbirth by entrapment - prolonged 2nd stage, infiltration for episiotomy
- Main artery that supplies blood to ext genitalia and the perineum
Largest branch of the internal iliac artery?
Superior Gluteal Atery
Ovarian Artery:
1. Arises from?
2. What level
Abdominal Aorta
Level L2
Branches of Internal Iliac Artery
I LOVE GOING PLACES IN MY VERY OWN UNDERWEAR
I - Iliolumbar Artery
L - Lateral Sacral Artery
G - Gluteal (superior + inferior)
P - (internal) Pudendal Artery
I - Inferior Vesical Artery
M - Middle Rectal Artery
V - Vaginal Artery
O - Obturator Artery
U - Uterine + Umbilical Artery
What vessel is most likely to be injured in SSF?
Inferior Gluteal - passes behind the sacrospinous ligament
Branches of internal pudendal artery?
Inferior Rectal Artery
Perineal Artery
Urethral Artery
Artery most likely to bleed in 3rd degree tear?
Inferior Rectal Artery (branch of internal pudendal artery)
Branches of external iliac artery?
Inferior Epigastric Artery
Deep Circumflex Arteries
What nerve is susceptible to damage during TAH using self retaining retractors?
Incidence?
Femoral Nerve
Incidence 11%
Occurs because of compression of the nerve on the pelvic sidewall
Nerve most frequently injured during retroperitoneal surgery / excision of endometriosis?
How does it present?
Obturator Nerve
Sensory loss upper medial thigh and motor weakness in the hip abductors.
Nerve susceptible to injury during pelvic sidewall surgery? eg. excision of external iliac lymph nodes
How does it present?
Genitofemoral Nerve
Paraesthesia over labia majora, mons pubis and femoral triangle
Incidence of ilioinguinal or iliohypogastric neuropathy following Pfannenstiel incision?
3.7%
Ilioinguinal and iliohypogastric nerve roots? Sensory innervation?
T12 - L1
Ilioinguinal: sensory innervation to the skin overlying the groin, inner thigh, labia majora
Iliohypogastric: sensation to skin of gluteal and hypogastric regions.
What artery lies medial to the round ligament and lateral to the obliterated umbilical arteries?
Inferior Epigastric Artery
Risk of damage to inferior epigastric artery during port insertion at laparoscopy?
2%
On TVUS in the transverse plane, the ovaries are located lateral to the uterus and medial and anterior to which vessel?
The internal iliac artery
(located lateral and posterior to the ovaries and the fallopian tubes, as well as the ureter)
Which device would allow combined coagulation and cutting for routine laparoscopic hysterectomy ?
Advanced Bipolar
What diameter of vessels can a standard ultrasonic device reliably seal?
5mm!
Which energy based devices used in vaginal tightening procedures have been most widely studied/ investigated in randomised trials?
Radio frequency
Rate of pelvic adhesions in women undergoing pelvic surgery?
> 55%
Maintenance fluid /ml/kg/day?
25-30ml/kg/day
Post op ileus after LSCS?
12%
After what time do thermal injuries to urinary tract present?
10-14 days
Uroperitoneum or fistula
