Intraoperative Procedures and Techniques Flashcards

During a cesarean section, the surgical first assistant is asked to apply fundal pressure to assist delivery of the fetal head. At what point in the procedure is this maneuver performed?

Answer: After the uterine incision is made and the fetal head is being delivered

Fundal pressure is applied after the uterine incision (hysterotomy) to assist the surgeon in delivering the fetal head through the uterine opening.

The surgical first assistant notices the patient's urine output has dropped to less than 0.5 mL/kg/hr during a prolonged abdominal case. What is the most appropriate immediate action?

Answer: Alert the anesthesia team to assess volume status and perfusion

Oliguria during surgery signals possible hypovolemia or inadequate renal perfusion and should be immediately communicated to anesthesia for assessment and volume optimization.

During an anterior cervical discectomy and fusion (ACDF), which vessel is at greatest risk if retraction on the medial side is excessive?

Answer: Carotid artery

The carotid artery lies just lateral to the surgical dissection plane in ACDF; excessive medial retraction or incorrect plane development can injure it.

When closing a midline laparotomy incision using a running suture, what suture-to-wound length ratio is recommended to minimize dehiscence?

Answer: 4:1

A suture-to-wound length ratio of at least 4:1 is evidence-based and associated with the lowest rates of incisional hernia and wound dehiscence.

During a laparoscopic Nissen fundoplication, the posterior vagus nerve must be identified and protected. Where is this nerve typically located?

Answer: Posterior to the esophagus within the esophageal mesentery

The posterior vagus nerve runs along the posterior esophagus and must be preserved during fundoplication to prevent gastroparesis and GI dysfunction.

When assisting during a modified radical mastectomy, the surgical first assistant helps define the axillary dissection boundaries. What is the superior border of the axillary dissection?

Answer: Axillary vein

The axillary vein defines the superior boundary of the axillary dissection; dissection above it risks injury to neurovascular structures of the arm.

During a laparoscopic cholecystectomy, intraoperative cholangiography (IOC) is performed. What is the primary purpose of IOC during this procedure?

Answer: To identify common bile duct anatomy and detect unsuspected stones or ductal injuries

IOC delineates ductal anatomy in real time, helping prevent bile duct injuries and simultaneously identifying retained common duct stones.