CSFA Intraoperative Procedures and Techniques 2 — Questions and Answers
Question 1: During laparoscopic surgery, the surgical first assistant notes the capnography reading rising steadily. What is the most likely cause?
- Hyperventilation by the anesthesia team
- CO2 absorption from pneumoperitoneum (Correct answer)
- Equipment malfunction in the insufflator
- Patient is becoming hypothermic
Correct answer: CO2 absorption from pneumoperitoneum
CO2 used to create the pneumoperitoneum is absorbed through the peritoneum, leading to rising end-tidal CO2 on capnography.
Question 2: When assisting with a bowel anastomosis, which layer is sutured first in a two-layer technique?
- Seromuscular layer
- Mucosal layer (Correct answer)
- Submucosal layer
- Mesenteric layer
Correct answer: Mucosal layer
In a two-layer anastomosis, the inner mucosal layer is sutured first, followed by the outer seromuscular layer.
Question 3: The surgical first assistant is retracting during a hepatic resection when significant hemorrhage occurs from a hepatic vein. What maneuver controls inflow to reduce bleeding while a repair is made?
- Cattell-Braasch maneuver
- Pringle maneuver (Correct answer)
- Kocher maneuver
- Mattox maneuver
Correct answer: Pringle maneuver
The Pringle maneuver involves compressing the hepatoduodenal ligament to occlude portal vein and hepatic artery inflow to the liver.
Question 4: During a thyroidectomy, the surgical first assistant should be especially vigilant about protecting which structure running along the posterior aspect of the thyroid?
- External jugular vein
- Recurrent laryngeal nerve (Correct answer)
- Phrenic nerve
- Vagus nerve trunk
Correct answer: Recurrent laryngeal nerve
The recurrent laryngeal nerve runs in the tracheoesophageal groove and injury causes hoarseness or airway compromise.
Question 5: A patient undergoing open abdominal surgery develops sudden hypotension and tachycardia midway through the procedure. The first assistant notices the surgical field is dry. What should be suspected?
- Anesthetic overdose
- Internal hemorrhage not visible in the field
- Pulmonary embolism (Correct answer)
- Vasovagal response
Correct answer: Pulmonary embolism
Sudden intraoperative hypotension with tachycardia and a dry field should raise suspicion for pulmonary embolism, especially in prolonged procedures.
Question 6: When using a monopolar electrosurgical unit near a nerve, what technique minimizes the risk of thermal injury to adjacent neural structures?
- Use higher power settings for shorter bursts
- Use bipolar electrosurgery instead (Correct answer)
- Apply current in continuous mode only
- Increase the distance of the dispersive electrode
Correct answer: Use bipolar electrosurgery instead
Bipolar electrosurgery confines current between the two tips, limiting the spread of thermal energy to surrounding tissues including nerves.
Question 7: During a Whipple procedure, the surgical first assistant is asked to assist with the pancreaticojejunostomy. What is the primary concern unique to this anastomosis compared to other GI anastomoses?
- Risk of mesenteric ischemia
- Pancreatic fistula formation from enzymatic leak (Correct answer)
- Higher rate of anastomotic stricture
- Increased risk of bile leak
Correct answer: Pancreatic fistula formation from enzymatic leak
The pancreatic anastomosis is the most technically demanding portion of the Whipple and pancreatic fistula is the most feared complication due to enzymatic tissue digestion.
CSFA Intraoperative Procedures and Techniques 2
During laparoscopic surgery, the surgical first assistant notes the capnography reading rising steadily.
What is the most likely cause?