570 Obstetrics and Gynecology Board Review •••
❍ When is a patient most likely to sustain injury during laparoscopy?
Entry access injuries account for over 50% of complications, especially small bowel and retroperitoneal vessels.
❍ What is the classic cardiac murmur associated with a gas embolism?
Millwheel; it is described as a churning cardiac murmur.
❍ What is the primary concern in a patient that reports increasing abdominal pain after laparoscopy?
Injury to the bowel or GU tract (ureter, bladder). Bowel injury in particular is often missed at the time of surgery.
❍ True or False: Hemostatic injuries to the bowel serosa do not need to be repaired.
True.
❍ If after the initial trocal placement visualization reveals small bowel mucosa, what is your next step?
With the trocar in place, a laparotomy is performed and the enterostomy is closed in a purse string fashion. This
may also be done laparoscopically.
❍ What bladder injuries can be managed expectantly?
Lacerations smaller than 5 mm may heal spontaneously if a Foley catheter is maintained for 4 to 5 days
postoperatively.
❍ Which test can confirm ureteral injury?
Intravenous indigo carmine is injected and cystoscopy should reveal dye from the ureteral orifices within
5 minutes.
❍ What test would you order on a patient who presents with a fever and right-sided abdominal and flank pain
2 days after undergoing a laparoscopic procedure?
Intravenous pyelogram is the procedure of choice to rule out ureteral injury.
❍ How can one prevent a post-laparoscopy incisional hernia from occurring?
By fascial closure in ports larger than 7 mm and/or the Z-track method (trocar insertion through skin then moving
trocar slightly to create a separate entry through the fascia (ie, not “straight-in” insertion).
❍ What is the size range of diagnostic and operative hysteroscopes?
Diagnostic: 4 to 5 mm.
Operative: 7 to 10 mm.
❍ What is the high-viscosity distension medium used in hysteroscopy?
Hyskon (32% dextran 70 in dextrose).
❍ What are the low-viscosity distension media used in hysteroscopy?
Normal saline, glycine (1.5% and 2.2%), 3% sorbitol, and 5% mannitol.