FLS Clip Application 1 — Questions and Answers
Question 1: What is the primary purpose of applying a clip during laparoscopic cholecystectomy?
- To mark the surgical site for postoperative imaging
- To occlude the cystic duct and cystic artery before transection (Correct answer)
- To retract the gallbladder fundus away from the liver
- To anchor the specimen bag during extraction
Correct answer: To occlude the cystic duct and cystic artery before transection
Clips are applied to the cystic duct and cystic artery to occlude them before transection, preventing bile leakage and hemorrhage.
Question 2: How many clips should be placed on the patient's side of the cystic duct before transection?
- One clip
- Two clips (Correct answer)
- Three clips
- Four clips
Correct answer: Two clips
At least two clips should be placed on the patient's (proximal) side of the cystic duct to ensure secure occlusion before transection.
Question 3: Which of the following is the most important step before applying a clip to the cystic duct?
- Confirming adequate pneumoperitoneum pressure
- Achieving the critical view of safety (Correct answer)
- Selecting the correct clip size
- Irrigating the operative field
Correct answer: Achieving the critical view of safety
The critical view of safety must be established to clearly identify the cystic duct and artery before clip application, preventing inadvertent bile duct injury.
Question 4: What is the recommended minimum distance from the common bile duct when placing the proximal clip on the cystic duct?
- 1 mm
- 2 mm
- 3 mm (Correct answer)
- 5 mm
Correct answer: 3 mm
A minimum of 3 mm from the common bile duct is recommended to avoid incorporating the bile duct in the clip and risking a bile duct injury.
Question 5: When applying a clip applier laparoscopically, what angle relative to the target structure provides the most secure clip placement?
- Parallel (0°)
- 45° angle
- Perpendicular (90°) (Correct answer)
- 120° angle
Correct answer: Perpendicular (90°)
Applying the clip perpendicular (90°) to the target structure ensures the clip fully spans the duct or vessel, providing the most secure occlusion.
Question 6: What should be done if a clip applier misfires or partially deploys a clip during laparoscopic surgery?
- Continue firing to fully close the clip
- Withdraw the instrument and reload before reapplying (Correct answer)
- Apply a second clip directly over the malformed one
- Proceed with transection as partial occlusion is sufficient
Correct answer: Withdraw the instrument and reload before reapplying
If a clip misfires, the instrument should be withdrawn from the patient and reloaded or replaced before reapplying to avoid leaving a malformed clip on a critical structure.
Question 7: Which clip material is most commonly used in modern laparoscopic clip appliers?
- Stainless steel
- Titanium (Correct answer)
- Absorbable polymer
- Cobalt-chromium alloy
Correct answer: Titanium
Titanium clips are most commonly used because they are lightweight, MRI-compatible, and provide strong occlusion without significant artifact on postoperative imaging.
FLS Clip Application 1
What is the primary purpose of applying a clip during laparoscopic cholecystectomy?