Core Surgical Skills

1. Your consultant is doing a diagnostic laparoscopy for a 30 year old woman who has presented to you with chronic pelvic vein. Your consultant has asked you to identify the marked structure. Identify the structure.

2. What is the rate of infra-umbilical adhesions after midline laparotomy?

3. An 18-year-old nulliparous girl presents as a gynaecological emergency with left-sided pelvic pain, tachycardia and vomiting. A pregnancy test is negative. An ultrasound scan is performed in the emergency department, which appears to demonstrate a left adnexal cyst. In theatre, a laparoscopy is performed which shows an ovarian torsion that has twisted three times on its pedicle. The left tube and ovary appear purple and congested. What is the most appropriate surgical management?

4. 26 years old Tesisly has delivered 6weeks back. She underwent cesarean section for prolonged rupture of membranes with suspected chorioamnionitis. Now she has presented with heavy vaginal bleeding. Her ultrasound shows retained membranes – she is ready for evacuation of uterus. What are her chances of having uterine perforation?

5. What is the most frequently encountered complication of suction evacuation of the uterus for first trimester miscarriage?

6. A 51 years old woman underwent a vaginal hysterectomy and pelvic floor repair. She had an uneventful recovery and was discharged on day 3. She returns as an admission 15 days later with pelvic pain, spiking temperatures and on examination – hypotensive, the pouch of Douglas feels probably full and tender. What is the initial management?

7. What proportion of patients having a surgical procedure will develop a surgical site infection?

8. At what pressure should the pneumoperitoneum be maintained during the insertion of secondary ports for a laparoscopic procedure?

9. You have been asked by your consultant to write a patient information leaflet on caesarean section for placenta praevia. What is the incidence of ureteric injury at the time of surgery?

10. A 55-year-old woman is due to come in for total abdominal hysterectomy and bilateral salpingo-oophorectomy for a large mucinous ovarian cyst. She takes sequential HRT for menopausal symptoms. What is the approximate overall risk of serious complications from abdominal hysterectomy?

11. How much time uterus (tissue) takes to heal?