Surgery (Forest) Flashcards
What is rate of ureteric injury at laparoscopy?
1%
Most common type of ureteric injury at laparoscopy?
Transection
2nd is thermal
What proportion of ureteric injuries are detected at the time of surgery?
1/3rd
2/3rds detected as readmission
How does ureteric injury present?
Urinary leak into peritoneum can cause ascites
Urinary output normal as other kidney compensates
Serious complication rate for laparoscopy?
1 in 1000 / 0.1%
How to you repair ureteric injuries at different points in it’s path?
Upper 1/3 - end to end
Middle 1/3 (e.g. pelvic brim) - anastamose to contralateral healthy tube
Lower 1/3 (e.g. vaginal vault)- reimplant into bladder using boari flap +/- psoas hitch
Commonest sites of ureteric injury during laparoscopy?
Ligation of gonadal vessels
Resecting endometrioma from ovarian fossa
Ligation of uterine vessels
Dissection of bladder/vagina
Anatomy of upper, middle and lower portions of ureter?
the upper part extends from the ureteropelvic junction to the area where the ureter crosses the sacroiliac joint, the middle ureter courses over the bony pelvis and iliac vessels, and the pelvic or distal ureter (lower) extends from the iliac vessels to the bladder
What is an advantage of open entry > closed?
reduces major vessel injury
(no difference in bowel injury between 2 methods)
How to manage ovarian torsion in young patient?
Untwist ovary, leave in situ, do not remove cyst (anatomy will be distorted)
Rescan 3 weeks after to assess ovarian function
94% of detorted ovaries become normal
Risk of chemical peritonitis if dermoid contents spill?
0.2%
Risk of death at laparoscopy?
Very rare, 3-8 in 100000
Risk of bowel, bladder, vessel injury at laparoscopy?
<1%
Pre-operative care for OP hysteroscopy?
NSAID 1 hour prior if no contraindications
When should you close the rectus sheath for laparoscopy port sites?
Midline ports if >10mm
Non midline ports if >7mm
Where does the inferior epigastric artery arise from?
Branch of external iliac artery
Adhesion rate after 1x previous LSCS
23%
Adhesion rate after midline laparotomy?
50%
Pros and cons of subtotal hysterecomy?
+ less intraoperative blood loss
- cyclical vaginal bleeding may occur
no difference in sexual, urinary or bowel function
How to manage uterine perforation if scope <5mm?
Observse and abx 5/7
How to manage uterine perforation if scope >5mm?
Consider laparoscopy
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What the risk of not being able to access uterine cavity at hysteroscopy?
1 in 1000, 0.1%, uncommon
What suture is used for a B lynch?
1 monocryl (a.k.a poliglecapone)
Which suture gives lowest infx risk?
monocryl
