CSFA Intraoperative Procedures and Techniques 3 — Questions and Answers
Question 1: During a robotic-assisted laparoscopic procedure, the surgical first assistant is positioned at the patient's bedside. What is the primary role of the bedside assistant during robotic surgery?
- Control the robotic arms remotely
- Exchange instruments, suction, and provide manual retraction as needed (Correct answer)
- Monitor the console surgeon's movements
- Manage CO2 insufflation pressure independently
Correct answer: Exchange instruments, suction, and provide manual retraction as needed
The bedside assistant exchanges instruments through non-robotic ports, provides suction, and offers manual assistance the robotic system cannot perform.
Question 2: A patient undergoing spinal surgery in the prone position develops intraoperative hypotension. What positional complication should the first assistant alert the team to evaluate?
- Brachial plexus stretch injury
- Abdominal compartment compression reducing venous return (Correct answer)
- Pressure sores on the heels
- Corneal abrasion from face pad
Correct answer: Abdominal compartment compression reducing venous return
In prone positioning, inadequate abdominal padding causes abdominal compression, increasing inferior vena cava pressure and reducing venous return to the heart.
Question 3: When performing a femoral-popliteal bypass, which conduit is preferred for best long-term patency?
- Synthetic PTFE graft
- Autologous saphenous vein (Correct answer)
- Dacron graft
- Umbilical vein allograft
Correct answer: Autologous saphenous vein
Autologous saphenous vein provides the best long-term patency for infrainguinal bypass due to its biological compatibility and resistance to infection.
Question 4: During an open cholecystectomy, the surgical first assistant identifies Calot's triangle. Which three structures form the boundaries of this triangle?
- Cystic duct, hepatic artery, and portal vein
- Cystic duct, common hepatic duct, and inferior surface of the liver (Correct answer)
- Common bile duct, cystic artery, and liver edge
- Cystic artery, hepatoduodenal ligament, and duodenum
Correct answer: Cystic duct, common hepatic duct, and inferior surface of the liver
Calot's triangle is bounded by the cystic duct inferiorly, the common hepatic duct medially, and the inferior surface of the liver superiorly.
Question 5: The surgical first assistant is closing a laparotomy incision. Which suture technique is most appropriate for fascial closure to reduce the risk of incisional hernia?
- Simple interrupted with absorbable suture
- Running mass closure with slowly absorbable or permanent suture (Correct answer)
- Figure-of-eight with chromic catgut
- Subcuticular running with monofilament
Correct answer: Running mass closure with slowly absorbable or permanent suture
Running mass closure using a slowly absorbable suture such as PDS or looped nylon provides superior tensile strength and reduces incisional hernia rates.
Question 6: A patient on the table experiences a sudden decrease in SpO2 during a right-sided thoracotomy. The surgical first assistant notices the ipsilateral lung is being retracted. What is the most likely cause?
- Mucous plug in the endotracheal tube
- One-lung ventilation issue with the contralateral lung (Correct answer)
- Surgical trauma to the diaphragm
- Tension pneumothorax on the left side
Correct answer: One-lung ventilation issue with the contralateral lung
During thoracotomy with one-lung ventilation, problems with the contralateral (ventilated) lung such as secretions, tube malposition, or collapse cause desaturation.
Question 7: When assisting during an open repair of an abdominal aortic aneurysm, what maneuver is performed to control proximal hemorrhage before clamping the aorta?
- Direct finger compression on the aorta at the diaphragm
- Infrarenal aortic compression against the spine (Correct answer)
- Femoral artery balloon occlusion
- Rapid packing of the retroperitoneum
Correct answer: Infrarenal aortic compression against the spine
Infrarenal aortic compression against the lumbar spine controls proximal bleeding temporarily while vascular clamps are applied.
CSFA Intraoperative Procedures and Techniques 3
During a robotic-assisted laparoscopic procedure, the surgical first assistant is positioned at the patient's bedside.
What is the primary role of the bedside assistant during robotic surgery?