CSFA Intraoperative Surgical Procedures 2 — Questions and Answers
Question 1: During a laparoscopic cholecystectomy, the surgical first assistant notes the cystic duct has not been clearly identified. What is the most appropriate next action?
- Clip and divide the structure immediately
- Alert the surgeon and advocate for further dissection of Calot's triangle (Correct answer)
- Convert to open procedure without consulting the surgeon
- Irrigate the field and proceed with clipping
Correct answer: Alert the surgeon and advocate for further dissection of Calot's triangle
Failure to clearly identify the cystic duct before clipping risks bile duct injury; the SFA must advocate for safe dissection before proceeding.
Question 2: When assisting with a total knee arthroplasty, which retractor is most commonly used to expose the medial compartment?
- Hohmann retractor (Correct answer)
- Deaver retractor
- Army-Navy retractor
- Richardson retractor
Correct answer: Hohmann retractor
Hohmann retractors are curved and designed to lever around bone, making them ideal for orthopedic joint exposure.
Question 3: A patient undergoing open abdominal surgery develops a sudden drop in SpO2 and elevated peak airway pressures. The surgical first assistant should first:
- Increase suction in the operative field
- Notify the anesthesia provider immediately (Correct answer)
- Apply direct pressure to the aorta
- Request additional electrocautery equipment
Correct answer: Notify the anesthesia provider immediately
Sudden SpO2 drop with elevated airway pressures suggests a ventilatory emergency requiring immediate anesthesia intervention.
Question 4: Which suture material is most appropriate for closing a contaminated abdominal fascia?
- Silk (non-absorbable multifilament)
- Poliglecaprone 25 (monofilament absorbable) (Correct answer)
- Polyglactin 910 (braided absorbable)
- Nylon monofilament
Correct answer: Poliglecaprone 25 (monofilament absorbable)
Monofilament absorbable sutures like poliglecaprone resist harboring bacteria compared to braided sutures in contaminated fields.
Question 5: During retraction of the bowel, which technique best prevents serosal injury?
- Using sharp Richardson retractors directly on bowel loops
- Packing moist laparotomy sponges around bowel before applying retractors (Correct answer)
- Applying towel clips to bowel walls for traction
- Using electrocautery to retract tissue
Correct answer: Packing moist laparotomy sponges around bowel before applying retractors
Moist laparotomy sponges cushion and protect the bowel serosa from injury by mechanical retractors.
Question 6: The surgical first assistant is controlling hemorrhage from a mesenteric vessel. Which maneuver provides immediate proximal control?
- Applying distal pressure only
- Digital pressure proximal to the bleeding point while suture ligature is prepared (Correct answer)
- Packing the entire abdomen and waiting
- Applying electrocautery immediately to the bleeding vessel
Correct answer: Digital pressure proximal to the bleeding point while suture ligature is prepared
Digital compression proximal to the bleeding vessel controls hemorrhage and allows time to prepare definitive hemostatic measures.
Question 7: When performing a surgical hand scrub using the anatomical (timed) method, what is the minimum required scrub duration per the Association of periOperative Registered Nurses (AORN) guidelines?
- 1 minute
- 3 minutes
- 5 minutes (Correct answer)
- 10 minutes
Correct answer: 5 minutes
AORN guidelines recommend a minimum 5-minute surgical scrub using the timed anatomical method for initial cases.
CSFA Intraoperative Surgical Procedures 2
During a laparoscopic cholecystectomy, the surgical first assistant notes the cystic duct has not been clearly identified.
What is the most appropriate next action?