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

An obliquely placed clip may not fully occlude the duct lumen, leaving a channel for bile to leak postoperatively, which is a common cause of post-cholecystectomy bile leaks.

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

Placing a clip too close to the gallbladder neck risks trapping stones in the cystic duct remnant, leading to retained stone syndrome and recurrent symptoms.

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

Ensuring 3–5 mm of jaw clearance on each side of the structure guarantees the clip fully encircles it and closes completely, reducing the risk of partial occlusion or misapplication.

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

Dilated bile ducts with a clip near the common bile duct on CT suggests the clip may have been misapplied or migrated to obstruct biliary flow, requiring urgent evaluation.

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

Fresh clips should be applied to the stump under direct visualization after confirming adequate duct length and tissue integrity; attempting to reuse a fallen clip introduces contamination and unreliable occlusion.

FLS - Fundamentals of Laparoscopic Surgery Practice Test

FLS - Fundamentals of Laparoscopic Surgery Practice Test

FLS Clip Application 3