Intra-operative complications

Question 1

Describe the course of the ureter

Answer 1

Exits the kidney
Descends along central surface of psoas 
Transitions into pelvis over the bifurcation of the common iliac 
Courses through Medial leaf of broad ligament
Through cardinal ligament 
(1.5 cm lateral to cervix)
Under the uterine artery 
Into the bladder trigone

Question 2

Repair of bladder injury

If >1 cm

Answer 2

3.0 vicryl running nonlocked to close mucosa

Interrupted layer to imbricate the muscularis and bladder serosa

Sterile milk
?cysto
Catheter for 7 days
CT cystogram prior to foley cath removal
No abx needed

Question 3

Postoperative fever causes

Answer 3

Wind (bowel obstruction, ileus, PNA
Water (UTI)
Wound 
Walking (DVT)
Wonder drug 
(Breasts)

Question 4

Symptoms of bowel injury

Mortality rate with delay diagnosis

Answer 4

Abdominal pain
Tachycardia
Tachypnea
Leukocytosis and fever
Severe electrolyte derangement

3%

Question 5

Repair of small bowel injury

Answer 5

Smaller than 1 cm may be closed and one or two layers in a perpendicular plane to bowel lumen

Large full thickness injuries require resection

Question 6

How does sciatic nerve injury occur and what are the sxs?

Answer 6

Hip flexed, knee extended
Weak knee flexion and dorsiflexion of foot (hamstrings)
Sensory loss on plantar surface of foot

Question 7

Peroneal nerve injury

Answer 7

Pressure over upper lateral tibial area

Foot drop

Question 8

Femoral nerve

Answer 8

Usually caused by compression By self retaining retractor and then patient

Sensory loss and anterior and medial thigh
Weakness of hip flexion and knee extension

Question 9

Common locations of ureteral injury

Answer 9

When transaction the IP ligament
Transecting uterine arteries
Closing vaginal cuff

Question 10

What can be used for hemorrhage of Jehovah’s witness patient

Answer 10

Plasma expanders, including albumin and hetastarch

Question 11

What is thermal spread of the Ligasure

Answer 11

1.5mm