Surgery (Forest)

Question 1

What is rate of ureteric injury at laparoscopy?

Answer 1

1%

Question 2

Most common type of ureteric injury at laparoscopy?

Answer 2

Transection
2nd is thermal

Question 3

What proportion of ureteric injuries are detected at the time of surgery?

Answer 3

1/3rd
2/3rds detected as readmission

Question 4

How does ureteric injury present?

Answer 4

Urinary leak into peritoneum can cause ascites
Urinary output normal as other kidney compensates

Question 5

Serious complication rate for laparoscopy?

Answer 5

1 in 1000 / 0.1%

Question 6

How to you repair ureteric injuries at different points in it’s path?

Answer 6

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

Question 7

Commonest sites of ureteric injury during laparoscopy?

Answer 7

Ligation of gonadal vessels
Resecting endometrioma from ovarian fossa
Ligation of uterine vessels
Dissection of bladder/vagina

Question 8

Anatomy of upper, middle and lower portions of ureter?

Answer 8

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

Question 9

What is an advantage of open entry > closed?

Answer 9

reduces major vessel injury
(no difference in bowel injury between 2 methods)

Question 10

How to manage ovarian torsion in young patient?

Answer 10

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

Question 11

Risk of chemical peritonitis if dermoid contents spill?

Answer 11

0.2%

Question 12

Risk of death at laparoscopy?

Answer 12

Very rare, 3-8 in 100000

Question 13

Risk of bowel, bladder, vessel injury at laparoscopy?

Answer 13

<1%

Question 14

Pre-operative care for OP hysteroscopy?

Answer 14

NSAID 1 hour prior if no contraindications

Question 15

When should you close the rectus sheath for laparoscopy port sites?

Answer 15

Midline ports if >10mm
Non midline ports if >7mm

Question 16

Where does the inferior epigastric artery arise from?

Answer 16

Branch of external iliac artery

Question 17

Adhesion rate after 1x previous LSCS

Answer 17

23%

Question 18

Adhesion rate after midline laparotomy?

Answer 18

50%

Question 19

Pros and cons of subtotal hysterecomy?

Answer 19

+ less intraoperative blood loss
- cyclical vaginal bleeding may occur

no difference in sexual, urinary or bowel function

Question 20

How to manage uterine perforation if scope <5mm?

Answer 20

Observse and abx 5/7

Question 21

How to manage uterine perforation if scope >5mm?

Answer 21

Consider laparoscopy
Send incident form

Question 22

What the risk of not being able to access uterine cavity at hysteroscopy?

Answer 22

1 in 1000, 0.1%, uncommon

Question 23

What suture is used for a B lynch?

Answer 23

1 monocryl (a.k.a poliglecapone)

Question 24

Which suture gives lowest infx risk?

Answer 24

monocryl