FLS Clip Application 3

Question 1

A clip placed on the cystic duct is found to be applied at an oblique angle after deployment. What is the main concern?

Accepted Answer

Incomplete duct occlusion leading to possible bile leak

Answer

Increased risk of postoperative MRI artifact

Answer

Difficulty with specimen bag insertion

Answer

Interference with subsequent clip placement on the artery

Question 2

What is the consequence of placing a clip too close to the neck of the gallbladder on the cystic duct?

Accepted Answer

Potential for a retained gallstone to be trapped in the cystic duct remnant

Answer

Increased operative time only

Answer

Inadequate pneumoperitoneum maintenance

Answer

Increased risk of trocar site hernia

Question 3

During laparoscopic clip application, the surgeon should ensure clearance of the clip applier jaws by at least how much on both sides of the target structure?

Accepted Answer

At least 3–5 mm of jaw clearance on each side

Answer

No clearance is required if the duct is well visualized

Answer

1–2 mm of jaw clearance on each side

Answer

At least 10 mm of jaw clearance on each side

Question 4

Which of the following postoperative imaging findings would most suggest a retained or migrated clip has caused a complication?

Accepted Answer

Dilated bile ducts with clip in proximity to the bile duct on CT

Answer

Clip visible adjacent to the gallbladder fossa on plain X-ray

Answer

Multiple clips aligned in a row on postoperative ultrasound

Answer

Air under the diaphragm on upright chest X-ray at 24 hours

Question 5

What is the appropriate management when a clip falls off the cystic duct stump intraoperatively during laparoscopic cholecystectomy?

Accepted Answer

Apply new clips to the stump under direct visualization after ensuring adequate tissue

Answer

Retrieve the lost clip from the abdomen and reapply it

Answer

Convert immediately to open surgery regardless of visualization

Answer

Leave the unclipped stump and close with fibrin sealant spray

Question 6

In laparoscopic training simulations, what metric is most commonly used to evaluate clip application competency?

Accepted Answer

Time to apply clips combined with accuracy of placement on target structures

Answer

Total number of clips used per session

Answer

Number of times the clip applier was reloaded

Answer

Pressure generated in the pneumoperitoneum during clip application

Question 7

When a cystic duct is wider than 9 mm (e.g., from chronic cholecystitis), what is the most appropriate method to secure it before transection?

Accepted Answer

Use a laparoscopic loop ligature or endoscopic stapler

Answer

Apply three overlapping standard clips across the width

Answer

Coagulate with bipolar energy alone

Answer

Apply clips on each edge of the duct only