15-Question Exam for Diploma in Laparoscopic Gynecology
Question 1: Port Placement and Selection
What is the recommended trocar size and placement strategy to minimize trocar-site hernia risk?
- A) Use 10-mm trocars in midline positions for all procedures
- B) Use the smallest trocar diameter possible, avoid midline placement, and close all fascial defects ≥10 mm
- C) Use bladed trocars exclusively for easier insertion
- D) Single-incision laparoscopic surgery is preferred over multiport approaches
Correct Answer: B 1
Question 2: Pneumoperitoneum Management
What is the recommended intra-abdominal pressure during laparoscopic gynecologic procedures?
- A) 20-25 mmHg throughout the entire procedure
- B) 15-20 mmHg for optimal visualization
- C) 10-15 mmHg (ideally 12 mmHg), with adjustments based on patient physiology
- D) 5-10 mmHg to minimize all complications
Question 3: Laparoscopic Approach in Cervical Cancer
For early-stage cervical cancer (stage IB1), what does current evidence support regarding laparoscopic radical hysterectomy?
- A) Laparoscopic and robotic approaches show equivalent long-term outcomes to open surgery
- B) Laparoscopic approaches are being used but lack long-term outcome data; recurrence rates appear low at 3-6 years follow-up
- C) Laparoscopic surgery is contraindicated for cervical cancer
- D) Only robotic surgery is acceptable, not traditional laparoscopy
Correct Answer: B 3
Question 4: Endometrial Cancer Staging
What is the standard surgical approach for apparent stage I endometrial cancer?
- A) Subtotal hysterectomy with ovarian preservation
- B) Total hysterectomy with bilateral salpingo-oophorectomy without vaginal cuff
- C) Total hysterectomy with mandatory para-aortic lymphadenectomy
- D) Hysterectomy with vaginal cuff excision in all cases
Correct Answer: B 3
Question 5: Laparoscopy vs. Laparotomy Outcomes
According to the LAP2 trial, what are the key differences between laparoscopic and open approaches for endometrial cancer staging?
- A) Laparoscopy has higher intra-operative complication rates
- B) Laparoscopy requires longer operative time but results in fewer moderate-to-severe postoperative adverse events (14% vs. 21%) and shorter hospital stays
- C) Laparotomy provides better lymph node retrieval
- D) No significant differences exist between approaches
Correct Answer: B 3
Question 6: Ovarian Preservation in Young Patients
In which scenario is ovarian preservation acceptable during hysterectomy for endometrial cancer?
- A) Any premenopausal patient with stage I disease
- B) Patients younger than 45 years with grade 1 endometrioid endometrial cancer, myometrial invasion <50%, and no obvious extra-uterine disease
- C) All patients under 40 years regardless of grade or stage
- D) Ovarian preservation is never recommended
Correct Answer: B 3
Question 7: Preoperative Assessment for Endometrial Cancer
What imaging modality should be used to assess myometrial invasion in apparent stage I, grade 1-2 endometrial cancer when lymph node dissection is being considered?
- A) CT scan is mandatory for all cases
- B) PET-CT provides the best assessment
- C) At least one of: expert ultrasound, MRI, or intra-operative pathological examination
- D) Imaging is unnecessary; proceed directly to surgery
Correct Answer: C 3
Question 8: Laparoscopic Skills Assessment
What validated assessment tool demonstrates construct validity for evaluating basic laparoscopic competency in gynecology residents?
- A) Only subjective attending evaluations are valid
- B) The Fundamentals of Laparoscopic Surgery (FLS) skills test, which shows significant correlation with surgical experience
- C) Written examinations alone are sufficient
- D) No validated tools exist for gynecology
Correct Answer: B 4
Question 9: Neoadjuvant Chemotherapy in Ovarian Cancer
For a patient with stage IIIC ovarian cancer who is fit for surgery but has disease distribution suggesting low likelihood of cytoreduction to <1 cm, what is the recommended initial approach?
- A) Primary cytoreductive surgery regardless of predicted outcome
- B) Neoadjuvant chemotherapy (NACT), as it is associated with less peri- and postoperative morbidity and mortality
- C) Radiation therapy followed by surgery
- D) Palliative care only
Correct Answer: B 3
Question 10: Laparoscopic Conversion Rates
What was the conversion rate to laparotomy in the LAP2 trial, and what was the most common reason?
- A) 10% conversion rate, primarily due to bleeding
- B) 25.8% conversion rate, with poor visibility reported in 14.6% of cases
- C) 5% conversion rate, primarily due to equipment failure
- D) 40% conversion rate, primarily due to adhesions
Correct Answer: B 3
Question 11: Smoke Evacuation During Laparoscopy
What safety measure is recommended regarding surgical smoke during laparoscopic procedures?
- A) Smoke evacuation is unnecessary in laparoscopy
- B) Use closed-circuit smoke evacuation or ultra-low particulate air filtration systems, and minimize energy device use with low power settings
- C) Standard room ventilation is sufficient
- D) Only required for procedures longer than 2 hours
Correct Answer: B 1
Question 12: Fascial Closure Requirements
Which trocar sites require fascial closure to reduce hernia risk?
- A) Only sites ≥12 mm
- B) All trocar sites regardless of size
- C) All trocar sites ≥10 mm
- D) Fascial closure is unnecessary with modern trocars
Correct Answer: C 1
Question 13: Laparoscopy in Pregnancy
What is the recommended intra-abdominal pressure for laparoscopic procedures in pregnant patients?
- A) Standard 15 mmHg throughout
- B) 20-25 mmHg for initial port placement, then reduced to 12 mmHg for the procedure
- C) Avoid laparoscopy entirely in pregnancy
- D) 8-10 mmHg maximum at all times
Question 14: Trocar Type Selection
What type of trocar is preferred to minimize trocar-site hernia rates?
- A) Bladed trocars for easier insertion
- B) Non-bladed trocars, as bladed instruments show statistically significant higher hernia incidence
- C) Trocar type does not affect hernia rates
- D) Disposable trocars only
Correct Answer: B 1
Question 15: Diagnostic Laparoscopy for Ovarian Cancer Assessment
What is the role of diagnostic laparoscopy in assessing resectability of advanced ovarian cancer?
- A) Laparoscopy is mandatory before any treatment decision
- B) Laparoscopy has been suggested to better assess tumor distribution and predict surgical resection, though its role remains undefined with insufficient data to prove superiority over clinical/radiologic studies
- C) Laparoscopy is contraindicated in ovarian cancer
- D) Laparoscopy has replaced CT imaging entirely
Correct Answer: B 3