Procedure

Question 1

Ports location and size for laparoscopic cholecystectomy

Answer 1

> Hasson technique
- 5-12mm Hasson trocar at umbilicus
- 3 additional port at 1-2cm below right costal margin
( 5-12mm inferior to xiphoid process, 5mm inferior to midclavicular line, 5mm inferior to anterior axillary line)

Question 2

Complication of laparoscopic cholecystectomy

Answer 2

• Gallbladder perforation (During dissection, cause spillage of bile)
• Vascular injury (Cystic artery)
• Bowel perforation
• Mesenteric injuries
• Bile duct injuries

Question 3

How to remove stone in ERCP

Answer 3

• Dormia basket
• Mechanical lithotripsy
• Balloon

Question 4

How to prepare patient for ERCP

Answer 4

• Fasting for >=4 hours prior
• Monitor baseline vital signs
• Notify endoscopist if allergic to contrast (steriods/ antihistamine/ non-ionic contrast)
• FBC/ PT/INR/ LFT (<72 hours) reviewed
• Recent imaging studies should be available (US/ CT/ MRI/ EUS)

Question 5

Complication of ERCP and how to manage

Answer 5

• Duodenal perforation (Require surgery or further therapy through the endoscope)
• Hemorrhage (Stopped through endoscope)
• Pancreatitis (Pain relief, usually settles over next 24-48 hours)
• Sepsis/ cholangitis (Antibiotics)