EBCOG – PART 1 – CORE SURGICAL SKILLS

1. With regards to safe entry techniques during laparoscopy:

A. The Veress needle should be inserted through the umbilical incision, angled at 45 degrees to the skin

B. Entry pressure into the abdomen should be more than 11 mmHg when the gas tube is attached to the Veress needle

C. It is important to push the Veress needle further into the abdomen following two audible clicks on insertion into the abdomen

D. It is important to move the Veress needle by lateral movements on obtaining high pressure on the monitor on insertion as it may be touching the omentum in the abdomen

E. The patient should be in Trendelenburg position when inserting a Veress needle through the umbilical incision

2. Complications during laparoscopy

A Fifty per cent of bowel injuries are not recognised at the time of surgery

B The risk of death is 8 in 100,000 as a result of complications

C The risk of serious complications is 2 in 10,000 women

D The risk of bowel injury is much less using Hassan’s technique than closed technique.

E The risk of visceral injury is higher with Veress needle insertion compared to direct trocar entry into the abdomen

3. With regards to safe entry and closing practice in laparoscopic surgery:

A Palmer’s entry into the abdomen is recommended in women with multiple previous abdomino-pelvic surgeries

B If the size of lateral ports is >10 mm, they should be closed with a J-shaped needle

C If the size of midline ports is >7 mm, they should be closed with a J-shaped needle

D The laparoscope should point towards the pelvis on first entry into the umbilical port

E Transillumination should be used to identify the inferior epigastric artery before insertion of the lateral ports

4. With regards to the surgical management of ectopic pregnancy:

A The Royal College of Obstetricians and Gynaecologists (RCOG) recommends salpingectomy on the side of the ectopic pregnancy if the contralateral tube is diseased

B The RCOG recommends salpingotomy on the side of the ectopic pregnancy if the contralateral tube is healthy

C Future pregnancy rates are higher when salpingotomy is performed compared to salpingectomy

D Future pregnancy rates are higher with open salpingectomy compared to laparoscopic salpingectomy

E The risk of recurrent ectopic pregnancy is more with salpingectomy compared to salpingotomy

5. With regards to paralytic ileus:

A It is associated with good tolerance to oral fluids

B It is associated with abdominal distension with good bowel sounds

C It is associated with bowel handling during surgery

D It is associated with delayed passage of stool or flatus

E It can be managed conservatively

6. With regards to bowel obstruction following gynaecological surgery:

A It is a very common complication

B It is usually apparent on the first postoperative day

C In the presence of peritonism, immediate surgery is necessary

D Recent reports show closure of the pelvic peritoneum decreases the incidence of bowel obstruction

E It can be managed conservatively in the absence of peritonism

7. With regards to bowel injury during gynaecological surgery:

A It is uncommon

B The incidence is <1%

C In 75% of cases, site of injury is the small bowel

D Vaginal surgery is associated with a higher rate of bowel injury compared to abdominal surgery

E It usually manifests on days 2–3 in the postoperative period if it goes unrecognised and unrepaired during surgery

8. With regards to abdominal incisions:

A A vertical midline incision avoids all major nerves and vessels

B A vertical midline incision gives very good access to subdiaphragmatic areas

C Transverse muscle-cutting incisions heal more rapidly than vertical incisions

D Cherney’s incision is similar to Pfannenstiel incision except rectus muscles are cut 1 cm from their insertion into the symphysis pubis

E Maylard’s incision involves dividing all layers of the abdominal wall at the same level as the skin incision and also involves division of the inferior epigastric artery