Gynae: Theatres

Question 1

Class I wound

Answer 1

clean

Question 2

Class II wound

Answer 2

clean/contaminated, eg. rest, biliary, vagina, appendix, ENT

Question 3

Class III wound

Answer 3

Contaminated eg. GI/bowel; cardiac massage; open fresh accidental wounds

Question 4

Class IV wound

Answer 4

Dirty/infected.

Old traumatic wounds with retained devitalized tissue and those that involve existing clinical infection or perforated viscera. This definition suggests that the organisms causing postoperative infection were present in the operative field before the operation.

Question 5

Vaginal hysterectomy - class of wound

Answer 5

Class II, clean/contaminated

Question 6

VH vs. TAH - outcomes

Answer 6

fewer infections and febrile episodes

Question 7

Gynae procedures requiring abx

Answer 7

• hysterectomy (any)
• Surgical evac/STOP (doxycycline)
• Surgery for POP or SUI,
• HSG with dilated tubes (doxycycline!)

Question 8

Gynae procedures that do not need abx

Answer 8

1) laparoscopy without direct access to uterus or vagina
2) hysteroscopy
3) urodynamics
4) IUD insertion
5) Evacs for RPOCs

Question 9

first choice abx for gynae prophylaxis

Answer 9

first generation cephalosporin eg. cefazolin

allergy: clindamycin 600mg IV or erythromycin 500mg IV

Question 10

abx for abortion

Answer 10

Doxycycline 100 mg po pre-procedure and 200 mg po post-procedure

Question 11

timing of abx prophylaxis (ie. Preop)

Answer 11

15-60 min prior to skin incision

Question 12

indications for repeat abx prophylaxis and at what time

Answer 12

if open abdomen >3h procedure, or if >1500ml EBL
THEN
repeat abx at 3-4 intro

Question 13

___% of SSIs occur following discharge from hospitals

Answer 13

84%

Question 14

at what BMI should a doubled dose of abx be considered

Answer 14

BMI >35

Question 15

veress insertion - best reliable indicator of correct placement

Answer 15

starting pressure <10mmHg

Question 16

open entry outcomes

Answer 16

less vascular injury but more bowel injury

Question 17

when to consider palmer’s point entry

Answer 17

1. umbilical entry considered complicated
2. after 3 failed attempts at umbilical insertion

Question 18

adequate intraperitoneal pressure for trocar insertion

Answer 18

20-30mmHG

(go by pressure not volume)

Question 19

surgery in pregnancy - What GA can use umbilical entry

Answer 19

14 weeks

Question 20

surgery in pregnancy - between 14-24 weeks, what entry?

Answer 20

open or palmer’s point

Question 21

surgery in pregnancy - laparoscopy can be done until what GA?

Answer 21

24 weeks

Question 22

Vilos technique refers to

Answer 22

CLOSED ENTRY

1. shifting the umbilicus caudally,
2. a low initial VIP (<10 mm Hg) indicating correct placement of the Veress needle,
3. high intraperitoneal pressure (20–30 mm Hg) before primary trocar insertion,
4. visual entry with the reusable threaded cannula
5. liberal use of the LUQ site for insufflation and/or entry.

Question 23

pts in which LUQ entry may be preferred

Answer 23

• umbilical or ventral hernia
• midline scar/adhesions
• high BMI
• palpable mass

Question 24

angle of veress insertion

Answer 24

closer to 45deg if normal BMI
closer to 90deg if high BMI

Question 25

palmer’s point location

Answer 25

3cm below left subcostal border in midclavicular line

Question 26

palmers point is contraindicated in

Answer 26

• previous splenic or gastric surgery,
• significant hepatosplenomegaly,
• portal hypertension, or
• gastro-pancreatic masses

Question 27

umbilicus location in high BMI

Answer 27

shifted caudally towards aortic bifurcation

Question 28

trocar injuries cause

Answer 28

overshooting and/or misdirecting a sharp trocar,
then failing to recognize the injury and act in a timely fashion

Question 29

risk of minor injuries with laparscopy vs laparotomy

Answer 29

40% lower