FLS FLS Pneumoperitoneum and Insufflation 2 — Questions and Answers
Question 1: What is the primary cardiovascular effect of elevated intraabdominal pressure (>15 mmHg) during laparoscopy?
- Increased venous return and elevated cardiac output
- Decreased venous return and reduced cardiac output (Correct answer)
- Increased heart rate with no change in preload
- Decreased systemic vascular resistance
Correct answer: Decreased venous return and reduced cardiac output
Elevated IAP compresses the inferior vena cava, reducing venous return and preload, which decreases cardiac output.
Question 2: The Palmer's point entry site for Veress needle insertion is located at:
- 2 cm below the umbilicus in the midline
- 3 cm below the left costal margin in the midclavicular line (Correct answer)
- Right iliac fossa, McBurney's point
- 2 cm above the pubic symphysis
Correct answer: 3 cm below the left costal margin in the midclavicular line
Palmer's point, 3 cm below the left costal margin in the midclavicular line, is used as an alternative entry site when umbilical adhesions are suspected.
Question 3: During laparoscopy, hypercarbia (elevated PaCO₂) occurs primarily because:
- CO₂ diffuses across the peritoneum into the bloodstream (Correct answer)
- The patient is over-ventilated
- CO₂ displaces oxygen in the alveoli
- High IAP increases dead space ventilation
Correct answer: CO₂ diffuses across the peritoneum into the bloodstream
CO₂ used for insufflation readily diffuses across the peritoneal membrane into the bloodstream, raising PaCO₂ and requiring increased minute ventilation.
Question 4: A 'hissing' sound heard when the Veress needle is inserted into the abdomen most likely indicates:
- Correct peritoneal entry with free gas flow (Correct answer)
- Needle placement into a hollow viscus
- Subcutaneous placement of the needle
- Vascular injury
Correct answer: Correct peritoneal entry with free gas flow
A hissing sound as gas flows freely indicates the needle tip is in the peritoneal cavity with low resistance, confirming correct placement.
Question 5: The 'aspiration test' during Veress needle placement involves attaching a syringe and aspirating; a positive (correct placement) result is:
- Bloody aspirate indicating vascular access
- Bile aspirate confirming peritoneal entry
- No aspirate and free saline instillation without resistance (Correct answer)
- Air aspirate confirming bowel entry
Correct answer: No aspirate and free saline instillation without resistance
No aspirate combined with free instillation of saline (which drops in without resistance) confirms the needle is in the free peritoneal space.
Question 6: Which patient position is most commonly used to facilitate pneumoperitoneum creation and trocar placement in pelvic laparoscopic surgery?
- Reverse Trendelenburg (head up)
- Lithotomy with Trendelenburg (head down) (Correct answer)
- Lateral decubitus
- Prone position
Correct answer: Lithotomy with Trendelenburg (head down)
Trendelenburg position causes bowel to fall toward the upper abdomen, clearing the pelvis for better visualization and instrument access.
FLS FLS Pneumoperitoneum and Insufflation 2
What is the primary cardiovascular effect of elevated intraabdominal pressure (>15 mmHg) during laparoscopy?