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Minimally Invasive Surgery

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All EXCEPT which of the following are contraindications to the use of pneumoperitoneum during laparoscopy?

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a. Acute glaucoma

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b. Peritoneal shunt

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c. Second-trimester pregnancy

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d. Increased intracranial pressure

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All EXCEPT which of the following may be used to effectively compensate for difficulties encountered during laparoscopy in an obese patient?

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a. Steeper Trendelenburg position to improve patient ventilation

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b. Veress needle insertion at an angle that is nearly perpendicular to the skin

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c. Placement of additional ancillary ports to assist in lifting a fattier omentum from the operating field

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d. Use of a gel pad beneath the patient and tucking of patient arms to limit patient slippage while in Trendelenburg position

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The medial umbilical ligament and round ligament are ideally identified prior to ancillary trocar placement through the lower anterior abdominal wall. This assists in minimizing injury to which of the following vessels?

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Photograph contributed by Dr. Mayra Thompson.

Graphic Jump Location
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a. Inferior epigastric artery

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b. Superior epigastric artery

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c. Superficial epigastric artery

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d. Superficial circumflex iliac artery

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When used for entry at the umbilicus, which of the following abdominal entry methods is associated with the lowest rate of puncture injury?

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a. Open umbilical entry

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b. Optical access trocar entry

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c. Closed entry with Veress needle

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d. All have similar rates

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With abdominal entry using the Veress needle, what threshold for initial abdominal pressure is used to reassure the surgeon regarding correct intraperitoneal needle placement?

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a. <3 mm Hg

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b. <8 mm Hg

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c. <15 mm Hg

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d. <20 mm Hg

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Transillumination of the anterior abdominal wall ...

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