Intraoperative Procedures and Techniques Flashcards

During a robotic-assisted laparoscopic procedure, the surgical first assistant is positioned at the patient's bedside. What is the primary role of the bedside assistant during robotic surgery?

Answer: Exchange instruments, suction, and provide manual retraction as needed

The bedside assistant exchanges instruments through non-robotic ports, provides suction, and offers manual assistance the robotic system cannot perform.

A patient undergoing spinal surgery in the prone position develops intraoperative hypotension. What positional complication should the first assistant alert the team to evaluate?

Answer: Abdominal compartment compression reducing venous return

In prone positioning, inadequate abdominal padding causes abdominal compression, increasing inferior vena cava pressure and reducing venous return to the heart.

When performing a femoral-popliteal bypass, which conduit is preferred for best long-term patency?

Answer: Autologous saphenous vein

Autologous saphenous vein provides the best long-term patency for infrainguinal bypass due to its biological compatibility and resistance to infection.

During an open cholecystectomy, the surgical first assistant identifies Calot's triangle. Which three structures form the boundaries of this triangle?

Answer: Cystic duct, common hepatic duct, and inferior surface of the liver

Calot's triangle is bounded by the cystic duct inferiorly, the common hepatic duct medially, and the inferior surface of the liver superiorly.

The surgical first assistant is closing a laparotomy incision. Which suture technique is most appropriate for fascial closure to reduce the risk of incisional hernia?

Answer: Running mass closure with slowly absorbable or permanent suture

Running mass closure using a slowly absorbable suture such as PDS or looped nylon provides superior tensile strength and reduces incisional hernia rates.

A patient on the table experiences a sudden decrease in SpO2 during a right-sided thoracotomy. The surgical first assistant notices the ipsilateral lung is being retracted. What is the most likely cause?

Answer: One-lung ventilation issue with the contralateral lung

During thoracotomy with one-lung ventilation, problems with the contralateral (ventilated) lung such as secretions, tube malposition, or collapse cause desaturation.

When assisting during an open repair of an abdominal aortic aneurysm, what maneuver is performed to control proximal hemorrhage before clamping the aorta?

Answer: Infrarenal aortic compression against the spine

Infrarenal aortic compression against the lumbar spine controls proximal bleeding temporarily while vascular clamps are applied.