CFA Surgical Procedures & Techniques 2 — Questions and Answers
Question 1: During laparoscopic surgery, the first assistant's primary role when the surgeon encounters unexpected bleeding is to:
- Immediately convert to open surgery
- Provide suction and retraction to maintain visualization (Correct answer)
- Apply direct pressure with a laparoscopic sponge
- Clamp the bleeding vessel with a hemostat
Correct answer: Provide suction and retraction to maintain visualization
The first assistant maintains visualization by providing suction and retraction, allowing the surgeon to identify and control the bleeding source.
Question 2: When performing a running suture closure of a fascial layer, the first assistant should:
- Pull the suture taut with each throw to eliminate slack
- Maintain slight tension on the suture tail while the surgeon advances (Correct answer)
- Hold the needle driver to reload the needle between passes
- Cut the suture after every third throw
Correct answer: Maintain slight tension on the suture tail while the surgeon advances
The first assistant maintains slight tension on the free suture tail to prevent loosening while the surgeon places each successive bite.
Question 3: A Pfannenstiel incision is most commonly used for which type of surgical procedure?
- Appendectomy
- Cholecystectomy
- Cesarean section or pelvic surgery (Correct answer)
- Right hemicolectomy
Correct answer: Cesarean section or pelvic surgery
The Pfannenstiel (transverse suprapubic) incision provides excellent access to pelvic organs and is standard for cesarean sections and gynecologic procedures.
Question 4: When assisting with a total knee arthroplasty, the first assistant's role during cement application is to:
- Mix the bone cement to the surgeon's specified consistency
- Irrigate and dry the bone surfaces while the surgeon applies cement (Correct answer)
- Apply tourniquet pressure increase to reduce bleeding
- Position the extremity in maximum flexion
Correct answer: Irrigate and dry the bone surfaces while the surgeon applies cement
The first assistant irrigates and thoroughly dries bone surfaces immediately before cementation to maximize cement interdigitation and fixation strength.
Question 5: During a Whipple procedure (pancreaticoduodenectomy), the anastomosis performed between the pancreatic duct and jejunum is called:
- Hepaticojejunostomy
- Choledochojejunostomy
- Pancreaticojejunostomy (Correct answer)
- Gastrojejunostomy
Correct answer: Pancreaticojejunostomy
The pancreaticojejunostomy reconnects the pancreatic duct to a loop of jejunum to restore exocrine pancreatic drainage after the Whipple resection.
Question 6: Which technique is used to test the integrity of a bowel anastomosis intraoperatively?
- Fluorescein dye injection
- Air leak test by submerging in saline and insufflating the bowel
- Methylene blue injection via nasogastric tube
- Both B and C are used depending on anastomosis location (Correct answer)
Correct answer: Both B and C are used depending on anastomosis location
Air leak testing (submerging in saline and insufflating) and methylene blue instillation are both used depending on the anastomosis location and surgeon preference.
Question 7: When retracting the liver during an upper abdominal procedure, the first assistant should be aware that excessive pressure can cause:
- Portal hypertension
- Hepatic vein laceration or liver capsule tears (Correct answer)
- Bile duct injury
- Splenic rupture
Correct answer: Hepatic vein laceration or liver capsule tears
Excessive retractor pressure on the liver can tear the liver capsule (Glisson's capsule) or lacerate hepatic veins, causing significant hemorrhage.
CFA Surgical Procedures & Techniques 2
During laparoscopic surgery, the first assistant's primary role when the surgeon encounters unexpected bleeding is to: