Robotic surgery, PPX antibiotics, Ileus

Question 1

What are the disadvantages of robotic surgery?

Answer 1

1. Longer operating time
2. More surgical incisions
3. Extensive learning curve
4. Increased medical costs of surgical procedures
5. Possible increased risk of vaginal cuff dehiscence

Question 2

What are the advantages of robotic surgery?

Answer 2

1. 3D vision
2. More accuracy in tissue manipulation
3. Safer application of thermal energy devices
4. Improved fine motor control in dissection/suturing
5. Potential decrease in operative blood loss
6. Allows a potential minimally invasive approach in more complex cases when an experienced surgical assistant is not available

Question 3

What are risk factors for surgical site infections?

Answer 3

1. Smoking
2. Obesity
3. Diabetes
4. Depth of subQ >3cm
5. Immunosuppression
6. Coexistent infection at remote body site
7. Vaginal colonization with organisms
8. MRSA status
9. Nutritional status

Question 4

What preoperative measures should be taken to prevent surgical site infections?

Answer 4

1. Treat all infections remote from surgical site prior to procedure
2. Do not shave incision site before procedure. it should be shaved immediately before procedure with electric clippers
3. Control serum glucose levels and avoid perioperative hyperglycemia (<200)
4. Advise patient to shower/bathe full body with soap or antiseptic night before skin incision
5. perform preoperative surgical site skin preparation with alcohol based agent
6. Use appropriate antimicrobial ppx within 1 hr before procedure start

Question 5

What ppx antibiotic is used for hysterectomies?

Answer 5

2g of ancef

Question 6

What ppx antibiotic is used for anterior and posterior repair?

Answer 6

2g of ancef

Question 7

What ppx antibiotics is used for vaginal slings procedures?

Answer 7

2g of ancef

Question 8

What ppx antibiotics is used for laparotomy without entry into vagina or bowel?

Answer 8

May consider 2g of ancef

Question 9

What ppx antibiotics is used for laparoscopy with no entry into bowel or vagina?

Answer 9

None

Question 10

What ppx antibiotics is used for LEEP/cone?

Answer 10

None

Question 11

What ppx antibiotic is used for HSG or chromotubation?

Answer 11

None unless abnormal tubes or history of PID.
Doxycycline 100mg BID for 5 days

Question 12

What ppx antibiotic is used for hysteroscopy?

Answer 12

None

Question 13

What ppx antibiotic is used for cystoscopy?

Answer 13

None if UA negative

Question 14

What ppx antibiotic is used for a D&C in non pregnant state?

Answer 14

None

Question 15

What ppx antibiotic is used for induced abortion or pregnancy related D&C?

Answer 15

Doxycline 200mg x 1 pre procedure

Question 16

When do you go to 3g of ancef for surgical ppx?

Answer 16

Weight >120kg

Question 17

When do you redose antibiotics in clean contaminated surgical procedure?

Answer 17

EBL>1500cc
Surgical time >4hrs from 1st dose of antibiotics

Question 18

What is the antibiotic of choice if there is a severe PCN allergy?

Answer 18

1. Clindamycin 900mg q6hr
2. Gentamicin and flagyl
3. Aztreonam 2g q4hr

Question 19

What are the symptoms of an ileus?

Answer 19

Abdominal distention, no bowel sounds

Question 20

What are the symptoms of a small bowel obstruction?

Answer 20

Cramping pain with high pitched bowel sounds

Question 21

What is the timing for ileus to show up?

Answer 21

2-3 days post surgery

Question 22

What is the timing for small bowel to show up?

Answer 22

5-7 days post surgery

Question 23

What would you see on x-ray for ileus?

Answer 23

Air in rectum
Peripheral gas in colon

Question 24

What would you see on X-ray for small bowel obstruction?

Answer 24

Central gas in small bowel with air fluid levels
No air in rectum

Question 25

What is an ileus?

Answer 25

When there is a lack of the normal muscle contractions that leads to a build up or blockage

Question 26

What is a small bowel obstruction?

Answer 26

A partial or complete blockage of the small bowel

Question 27

Where would you make the incisions for an imperforate hymen?

Answer 27

2,6,10 o'clock

Question 28

What is an imperforate hymen?

Answer 28

Thin membrane extending across the hymen blocking the opening of the vagina

Question 29

What is the point of maximal tenderness in patients with appendicitis?

Answer 29

McBurneys point

Question 30

Where is McBurney's point?

Answer 30

Line drawn from navel to anterior superior iliac spine and 2/3 down that line

Question 31

What are the benefits of appendectomy?

Answer 31

1. Potential to prevent a future emergency appendectomy 2. Exclude potential diagnosis of appendicitis 3. With chemotherapy or radiation

Question 32

When is appendectomy not recommended?

Answer 32

>50 years old

Question 33

How do you perform an appendectomy?

Answer 33

1. Dissect mesa-appendix and ligate appendix vessels 2. Clamp and cut base of appendix 3. Place purse string suture around base 4. Invert stump prior to closing purse string suture