FLS Pneumoperitoneum and Insufflation Flashcards

What is the most important step to confirm correct Veress needle placement BEFORE beginning insufflation?

Answer: Perform the hanging drop test or aspiration test

The hanging drop test and aspiration test together confirm peritoneal entry and absence of bowel or vascular injury before gas is introduced.

Which of the following is a contraindication to the use of CO₂ pneumoperitoneum?

Answer: Severe COPD with CO₂ retention

Patients with severe COPD who already retain CO₂ may not be able to adequately eliminate the additional absorbed CO₂, leading to dangerous hypercarbia.

During insufflation, the intraabdominal pressure initially reads 20 mmHg at a flow of 1 L/min. This most likely indicates:

Answer: Extraperitoneal or visceral placement of the Veress needle

A high opening pressure at low flow suggests the needle tip is not in free peritoneal space — it may be in omentum, bowel, or preperitoneal fat.

When terminating pneumoperitoneum at the end of a laparoscopic procedure, the surgeon should:

Answer: Desufflate completely before removing trocars to minimize shoulder pain

Complete desufflation removes CO₂ that would otherwise track to the diaphragm and cause referred shoulder pain (phrenic nerve irritation) postoperatively.

The open (Hasson) technique for peritoneal access is preferred over the Veress needle technique in patients with:

Answer: Prior midline abdominal surgery with suspected adhesions

The Hasson technique provides direct visualization of the peritoneal entry under the scar, reducing risk of trocar injury to adhesed bowel or vessels.

In the FLS skills lab, the simulated 'insufflation' box trainer assesses the learner's ability to:

Answer: Perform precise manipulation tasks under camera visualization within a confined space

The FLS box trainer simulates a pneumoperitoneum environment (a closed box with a camera) to teach and assess laparoscopic manual skills under realistic spatial constraints.