FLS Module 1 Future Laparoscopic Surgeons Test Practice 2026, Exams of Nursing

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FLS Module 1 Future Laparoscopic Surgeons Test Practice 2026

“1 I I I I I I I I I I I I I I I I I I I I I I I I al FLS Module 1 Future Laparoscopic Surgeons Test Practice 2026 What are the laparoscope diameters? - CORRECT ANSWER -2-1 Omm Which degree scope is best for a field in line wich pore? - GORREGIANSWERI0 degree How to prevent fogging of scope? - SORRECIPANSWERI-Use anti fog solution or put scope in hot water/hot bath What is the most commonly used light source? - CORRECT ANSWER -300 W Xenon lamp ‘What if there is initial low pressure and high flow rate at entry? - GORRECTANSWER!-Leak in insufflacor circuit, make sure everything plugged in correctly Benefits of monopolar - GORRECTANSWER Tissue is heated quickly, less thermal damage/coagulation Monopolar yohtage/frequency - GORRECTIANGIVERI-Low voltage/High frequency What does coagulation mode do? - GORREGIEINSWER-Repid surface heating with shallow depth of necrosis, intermittent wave form with higher voltage Risk of monopolar - GORREGHENSWVERI-Currenc can be diverted through unintentional pathways, leading to inadvertent tissue injury. Don't use hybrid ports that mix metal with plastic r I I I I I I I I I I I I I I I I I I I I I I I I L “1 I I I I I I I I I I I I I I I I I I I I I I I I al Why do you need a grounding pad for monopola:? - ({ORIRBGINAINSWER).Capacitative coupling -tcansfer of energy between two conductors separated by an insulator, transfer to passive electrode. Can release with tissue injury, buc no issue if ground place is working as capacitor can't store the charge Benefits of bipolar - GORRECTANSWER lower energy, producing less lateral tissue damage and necrosis. Don't need a grounding pad Risk of bipolar - CORRECT ANSWER Risk of cutting patient vessels before adequate sealing, and device doesn't work if there is metal between the jaws Risk of ultrasonic dissection (harmonic) - GORRECTANSIWER Active blade can injure something due to high frequency (50mHz) Discontinue aspirin day of surgery? - CORRECT ANSWER-No GORRECTANSWERL Direct visualization How to enter in patient with bowel obstruction? Cut vs Coag CORRECT ANSWER -cuc - heat tissue quickly to convert cell water to steam, lysing the cell Coag - heat more widely dispersed, less cutting action smaller tissue area, greater current densicy and faster heating CORRECT ANSWER-<.g. Bovie tip Cut mode - CORRECT ANSWER -- Low voltage - High frequency - Continuous waveform - Heats tissue quickly; cell water converts to steam and causes cell to explode r I I I I I I I I I I I I I I I I I I I I I I I I L a | Ds ce eee ee ee es ultrasonic coagulation shears - CORRECT ANSWER - combo compression and friction - ONE active blade - monopolar capacity w/ the one blade - no capacitative coupling ~ high power (MAX): cut - low power (MIN): coag How many days prior to surgery does warfarin has to be discontinued? - CORRECT ANSWER 3 days ASA 2- GORRECTENSWER Mild to moderate systemic disease ASA 3- CORRECTANSWER) severe systemic disease that limits patient activity, may or may not be related to reason for surgery ASA 4- CORRECTANSIWER) Severe systemic disturbances that limit patient and are life-threatening with or without surgery ASA5- GORRECTENGWER Litcle change for survival but surgery last resort (resuscitative effort) ASA classes that may not be appropriate for LSC sx - CORRECT ANSWER -ASA 4and 5 - body cannot handle decreased venous return, need for hyperventilation Length of trocar needed for obese pt - CORRECT ANSWER ->100 mm ABSOLUTE C/I to LSC Sx - @ORREGIANSWERI— Inability co tolerate laparotomy bua ee ee ee ee eee ee ee ee ee eee eee eee “1 I I I I I I I I I I I I I I I I I I I I I I I I al - Hypovolemic shock - Lack proper surgeon training/experience - Lack appropriate institutional support Relative C/I to LSC Sx - SORREGHENSWER!— Inability to tolerace GETA ~ Long-standing peritonitis - Large abd/pelvic mass - Massive incarcerated ventral and inguinal hernias ~ Severe cardiopulmonary dz NOT C/I to LSC Sx- CORRECT ANSWER - Diaphragm injury - GI bleed - Performed viscus - Bowel obstruction - Abd trauma if HD stable - COPD - Renal insufficiency Preop precautious- CORRECT ANSWER Be avare of - Visceral arterial aneurysm (risk injury w/ trocar insertion) - prior ventral hernia repair w/ mesh (NO blind entry w/ veress or trocar through mesh!) - H/o peritonitis (risk adhesions and enterotomy) - Cirrhosis (increased risk of bleeding and ascites leak through ports/wounds) - Intestinal obstruction r I I I I I I I I I I I I I I I I I I I I I I I I L “1 I I I I I I I I I I I I I I I I I I I I I I I I al - check adequate relaxation - check intravascular volume status ~ check other causes of hypotension (e.g. bleeding) - once stabilized and r/o other causes, reinsufflate slower and w/ lower pressure During the case pt suddenly becomes hypotensive, tachycardic. You note JV distention and audible mill wheel murmur on cardiac auscultation, What to do? - CORRECT ANSWER-CV collapse from gas embolism! - place pt in trendelenberg position, left-side down - rapid IVF - central line placement to back up embolus in right heart chambers LSC examination of small bowel - GORRECHANSWER! place monitors- one near head (ligament treitz), one near feet (ileocecal valve place ports along left abd IN SBO pr, start at ILEQCECAL valve (most distal, should be most decompressed) FNA uses G needle - CORRECT ANSWER -20-22 G Core biopsy uses a G needle - CORRECT ANSWER -14-1 6G LSC suturing technique - CORRECT ANSWER -- ports at least 10 cm apart to allow intracorporeal knot tying - 10-12 mm trocar accommodates standard SH needle Length of suture for intracorporeal knot tying - CORRECT ANSWER-6 inches (15 cm) r I I I I I I I I I I I I I I I I I I I I I I I I L “1 I I I I I I I I I I I I I I I I I I I I I I I I al Length of suture for extracorporeal knot tying - CORRECT ANSWER -30) inches (76 cm) 2-2.5 mm staples used for - CORRECT ANSWER -- white/grey in color - vascular, thinner tissue 3-3.5 mm staples - CORRECT ANSWER — blue - for majority GI tract 4-4.5 mm staples - CORRECT ANSWER -- green - for distal stomach, thickened portions of GI tract Monopolar cautery - SORREGIPANS WER smaller vessels, slow rate bleeding, need relatively dey operative field Days until full diet colerated - CORRECT ANSWER -1-2¢ for fundoplication 3-6d for colon resection Postop - vascular injury smaller vessels - SORRECIVANSWER! usu superior/inferior epigastric vessels, mesenteric arteries/veins --> abd wall or peritoneal hematomas. - Surgery if con't bleeding, infxn, HD instability In the event of a blank screen, which is NOT a likely problem site? - CORRECGIANSWERI-FRED anti-fog solution r I I I I I I I I I I I I I I I I I I I I I I I I L “1 I I I I I I I I I I I I I I I I I I I I I I I I al which of the following is a relative contraindication to laparoscopic surgery? - CORRECT ANSWER - previous abdominal surgery which of these is NOT an absolute contraindication to laparoscopic surgery? - GORRECMANSWERL bowel obstruction (contraindications include uncorrectable hypovolemic shock, lack of proper surgical training, and inability co colerate laparotomy) which procedure may be performed using local anesthesia alone or with mild sedation: BINSWWERY diagnostic laparoscopy avoidance of position related complications, prevention of DVT, and location of target organ important features in patient positioning for laparoscopic surgery include: the most commonly used anesthetic for laparoscopic procedures is general anesthesia. all of the following are true EXCEPT - GORRECTANSWER! there are fewer hemodynamic changes compared to a local anesthetic (true answers are it allows for complete neuromuscular relaxation, it provides good control of ventilation, an tit allows for more flexibility of patient positioning) what is the most common site for initial trocar insertion? - GORRECHANSWERIumbilicus When checking placement of Veress needle, which of the following is the most accurate method to detect proper intraperitoneal placemen’ - CORRECT ANSWER, low initial pressure insufflator display revealing flow of CO2 and umbilical Veress needle insertion and blind tracer insertion is contraindicated in all of the following EXCEP CORRICTANSWER! previous open cholecystectomy via right subcostal incision (correct answers include previous left hemicolectomy through midline incision, previous hysterectomy through midline incision, previous Crohn's disease with enterocutaneous fistula, and previous umbilical hernia repair bua ee ee ee ee eee ee ee ee ee eee eee eee Ds ce eee ee ee es “1 I I I I I I I I I I I I I I I I I I I I I I I I al what is the best area for alternate Veress needle insertion relative to a midline vertical scar? CORRECT ANSWER) Palmer's point (LUQ) Extra caution must be taken when placing the Veress needle and primary trocar in the midline such as at the umbilicus due to concerns with injury to what organ? - GORREGIANSWER-Aorta (and IVC) When should a check for venous bleeding be performed? - GORREGMANSWER)-during final abdominal inspection, while releasing abdominal pressure, and during trocar removal once the operative procedure is finished, the surgeon should check which of the following areas before exiting the abdomen? CORRECT ANSWER. the operative field, the dependent portions of the abdomen away from the field of view ac the operative site, and the abdominal wall a each port site once the port has been removed Whar is the reason fascia at crocar sites is sucured (closed)? Why is COQ2 the preferred gas for establishment of pneumoperitoneum? CORRECTANSWER «pt absorbed Easily eliminated Supresses combustion Readily available Relatively inexpensive CO2 pneumoperitoneum chemical effects - GORRTCTANS WER Increase arterial CO2 concentration Increase end tidal CO2 Decrease serum pH Vigilant moitoring in patients with severe cardiopulmonary disease bua ee ee ee ee eee ee ee ee ee eee eee eee Ds ce eee ee ee es “1 I I I I I I I I I I I I I I I I I I I I I I I I al Helium Argon Nitrous Oxide BENEFITS as insufflation gas compared to CO2 - CORRECT ANSWER. Less acid-base disturbances May be better tolerated in patients with severe cardiopulmonary disease Tolerated relatively well without general anesthesia Slightly less postoperative pain Nitrous Oxide RISKS as insufflation gas compared to CO2 - CORRECT ANSWER. Fire hazard if using electrocautery in the presence of open bowel (supports combustion) Inert gases (argon & helium) BENEFITS as insufflation gas compared co CO2 - GORRECIINSWER! No hypercarbia and acidosis Inert gases (argon & helium) RISKS as insufflation gas compared to CO2 - CORRECT ANSWER -Less soluble in blood —> increase risk gas embolism (extraperitoneal gas extravasation) more expensive Insufflators designed for their use not readily available Cardiovascular changes with pneumoperitoneum - G@@ORREGIAINSIVERE Increased preload and afterload Decreased cardiac output ~> hypotension, cardiac arrhythmia, decreased urine output, increased end tidal CO2 (signs and symptoms of reduced tissue perfusion) Cardice archythmias due to pneumopericoneum - SOREGIANSIER! Sinus achyeardia Premature ventricular contractions bua ee ee ee ee eee ee ee ee ee eee eee eee Ds ce eee ee ee es “1 I I I I I I I I I I I I I I I I I I I I I I I I al Bradycardia How much does venous flow rates drop during pneumperitoneum? - GORRECTANSWER26-39% What is the incidence of VTE following laparoscopic colocystectomy? - GORRECTANSWER0.5% Renal effects of pneumoperitoneum - SORRECTPANSWERY Intraoperative oliguria (increased intraabdominal pressure > decreases renal blood flow --> decrease filtration and urine ourput > 2cy release of renin and ADH --> sodium and free water reabsorption --> oliguria) Postoperative oliguria usually resolves within a couple hours Strategies to avoid hypothermia - GORRECMANSWER Warmed IV fluids Forced air body surface warmer ‘Warm room temperature Warm irrigation fluid What is the Incidence of gas embolism during LSC Sx? CORRECT ANSWER-< 1% Gas embolism diagnosis - CORRECTANSWER Severe hypotension, JVD, tachycardia, Mill wheel murmur (characteristic) [RVo other source of hypotension: bleeding, pneumothorax, Lry cardiac failure) Gas embolism treatment - GORRECTHANSIVERL Abrupt cessation of insufflation Vacuation of pneumoperitoneum Place patient in Trendelenburg, Lt side down position Rapid fluid administration r I I I I I I I I I I I I I I I I I I I I I I I I L “1 I I I I I I I I I I I I I I I I I I I I I I I I al Why is recommended to actively evacuate as much of the pneumoperitoneum as possible at the conclusion of CORRECTANSWER-Help reduce postoperative pain the intraabdominal portion of the procedure? In what age group port sites Smm or smaller require closure of the fascia? - GORRECTANSWER! Pediatric CORRECT ANSWER-Opsn Abdominal wall closure of the port sites can be accomplished using... techniques Laparoscopic-assisted techniques Entirely laparoscopic techniques When should a check for venous bleeding be performed? CORRECT ANSWER. During final abdominal inspection, while releasing abdominal pressure, and during trocar removal Once the operative procedure is finished, the surgeon should check which areas before exiting the abdomen? - GORRECTEANGWER 0 perative field, dependent portions of the abdomen away from the field of view at the operative site, abdominal wall ac each port site onece the port has been removed what is the correct patient position for diagnostic laparoscopy for pelvic procedure? dorsal lithotomy ion for diagnostic laparoscopy for appendectomy? - CORRECT ANSWER - what is the correct patient po: trendelenburg which of the following pathology can be diagnosed laparoscopically? - GORRECTANSWERLCrohns, traumatic diaphragm injury, and ovarian cyst r I I I I I I I I I I I I I I I I I I I I I I I I L “1 I I I I I I I I I I I I I I I I I I I I I I I I al what are of the abomden is best for placement of ports to view kidneys and adrenal glands? - GORREGH AINSWVERE-Upper abdomen (epigastric, RUQ, LUQ) retraction of the uterus can be accomplished by? GORRECTENGWER transvaginal manipulator, blunt grasper, laparoscopic retractor, and suture placed through abdominal wall In general, if an ovarian cyst is larger than Sem or has complex internal US findings, biopsy should be done ty? - GORREGHANSIEERE sophoretomy general principles of successful laparoscopic tissue biopsy include all of the following EXCEPT: - GORREGT ANSWER temove biopsy specimen with an energy source to avoid bleeding (correct answers include avoid contacting tissue of extraction site with specimen, excisions biopsy of small lesions is appropriately, generally avoid biopsy of fluid filled liver lesions) (CORRECTIANSWER sping hs needle is the ideal way to control it when transporting the suture in and out of the abdomen which of the following about intracorporeal suturing is not true? true statements include: the ideal suture length is about Ginches, the ideal orientation for suturing is from 3 o'clock to 9 o'clock, pulling the needling along its arc through the tissue will minimize damage general principles regarding hemostasis during laparoscopy include all of the following EXCEPT: - pplying vascular clips to the general area is usually sufficient correct statements include: it is best to specifically identify the bleeding point, avoiding injury to adj structures is important, adding extra ports may be necessary, conversion to open may be necessary all of the following are generally true regarding port site bleeding EXCEPT - GORRECTANSWER there is no need to remove ports under direct visualization r I I I I I I I I I I I I I I I I I I I I I I I I L “1 I I I I I I I I I I I I I I I I I I I I I I I I al Relative contraindications to Blind initial trocar insertion - GORRECTANSWER! Previous abdominal surgery Previous intra-abdominal inflammatory process Absolute contraindications to Blind initial trocar insertion - GORRECTANGWER Abdominal scar from prior open operation in immediate vicinity of trocar insertion Through previously placed intraperitoneal mesh for hernia repair Types of trocar tips - GORRECTANGWER Knife blade tip Plastic tip Protective spring loaded shield Optical tip Complications of Veress Needle insertion - GORRECTANSWER! Bowel injury Mesenteric or omental vascular injury Retroperitoneal vascular injury Cardiac arrhythmia Hypotension High airway pressures Pneumothorax (w/initial gas insufflation) Gas embolism (w/initial gas insufflation) AINSIVERETo avoid injury to the inferior epigastric vessels (cannot be seen with translumination of the Why additional (secondary) trocars should not be placed in the middle of the rectus muscles? abdominal wall r I I I I I I I I I I I I I I I I I I I I I I I I L “1 I I I I I I I I I I I I I I I I I I I I I I I I al When checking placement of the Veress needle, which is the most accurate method to detect proper inccaperitoneal placement? - GORRECMANSWER! Insufflacor display revealing flow of CO2 and low initial pressure GORREGTANS WER. Cardiac rhythm Monitoring during pneumoperitoneum Pulse oximetry End tidial CO2 HR Blood pressure Urine oucput Upper Abdominal Laparoscopy - Position and equipment - CORRECT ANSWER. Arms can be out on arm boards Reverse Trendelenberg position (need foot board and leg strap) May need: > co retract liver (retractor and holder) > biopsy and hemostasis tools > Ultrasound or C-arm > Suturing capability Diagnsotic laparoscopy for suspected pelvic pathology - GORREGMANGMVER Arms tucked Trendelenberg position Plan for retraction of uterus: uterine manipulator, laparoscopic retractor, suture retraction to abdominal wall Plan for biopsy (equipment, instruments, hemostasis, pathologist consultation) r I I I I I I I I I I I I I I I I I I I I I I I I L