Multiple Choice Questions for Laparoscopic and Hysteroscopic Diploma Examination
Question 1: Surgical Approach Selection
A 38-year-old woman with multiple intramural fibroids (largest 8 cm) requires myomectomy. Which surgical approach is most appropriate?
A) Hysteroscopic myomectomy
B) Laparoscopic myomectomy
C) Open myomectomy
D) Vaginal myomectomy
Correct Answer: C
Rationale: Open myomectomy is preferred over laparoscopic approaches in patients with multiple fibroids or very large uteri 1. Laparoscopic or open myomectomy is indicated for subserosal or intramural fibroids, while hysteroscopic myomectomy is specifically for submucosal fibroids 1.
Question 2: Hysteroscopic Myomectomy Complications
What is the most serious intraoperative complication that can be detected by simultaneous laparoscopic monitoring during hysteroscopic myomectomy?
A) Excessive bleeding
B) Uterine perforation
C) Cervical laceration
D) Endometrial injury
Correct Answer: B
Rationale: Laparoscopic monitoring may detect uterine perforation in time during hysteroscopic procedures 2. Uterine perforation is listed as a significant risk of hysteroscopic myomectomy along with fluid overload, need for blood transfusion, and bowel or bladder injury 1.
Question 3: Laparoscopic Surgery in Pregnancy
What is the maximum recommended intra-abdominal pressure for laparoscopic surgery during pregnancy?
A) 8-10 mmHg
B) 10-13 mmHg
C) 15-18 mmHg
D) 20-25 mmHg
Correct Answer: B
Rationale: The recommendations for laparoscopic surgery during pregnancy include low intra-abdominal pressure of 10-13 mmHg, procedures no longer than 90-120 minutes, with open introduction and an experienced surgeon 1.
Question 4: Hysterectomy Route Selection
For a patient requiring hysterectomy for benign uterine disease, which approach is associated with the shortest hospital stay and fastest return to normal activities?
A) Abdominal hysterectomy
B) Vaginal hysterectomy
C) Laparoscopic hysterectomy
D) Both B and C
Correct Answer: D
Rationale: The least invasive route for hysterectomy should be performed, with vaginal or laparoscopic hysterectomy preferred over abdominal approach 3. Vaginal hysterectomy is associated with shorter operating times and faster return to normal activities, while laparoscopic hysterectomy is associated with faster return to normal activities and shorter hospital stays compared to abdominal hysterectomy 1.
Question 5: Fertility Outcomes After Myomectomy
What percentage of patients achieve live birth after hysteroscopic myomectomy according to retrospective studies?
A) 35%
B) 50%
C) 65%
D) 85%
Correct Answer: C
Rationale: Retrospective studies demonstrate pregnancy rates of 85% after hysteroscopic myomectomy with live birth rates of 65% 1. Large prospective registries show no significant difference in fertility outcomes among hysteroscopic, laparoscopic, and open myomectomy 1.
Question 6: Laparoscopic Surgery Timing in Pregnancy
In which trimester is laparoscopic surgery preferably performed during pregnancy?
A) First trimester
B) Early second trimester
C) Late second trimester
D) Third trimester
Correct Answer: B
Rationale: Surgery is preferably carried out in the (early) second trimester when the risk of miscarriage is decreased and the size of the uterus still allows a certain degree of access 1. Laparoscopy in pregnancy is feasible but depends on gestational age, surgeon's experience, type of procedure and the organs of interest 1.
Question 7: Hysteroscopic Myomectomy Indications
Which fibroid location is the primary indication for hysteroscopic myomectomy?
A) Subserosal fibroids
B) Intramural fibroids
C) Submucosal fibroids
D) Pedunculated fibroids
Correct Answer: C
Rationale: Hysteroscopic myomectomy is indicated for submucosal fibroids, while laparoscopic or open myomectomy is performed for subserosal or intramural fibroids 3. Hysteroscopic myomectomy involves transvaginal, transcervical placement of a hysteroscope and removal of submucosal uterine fibroids 1.
Question 8: Postoperative VTE Prophylaxis
What is the recommended VTE prophylaxis approach for very high-risk patients after laparoscopic surgery?
A) Mechanical prophylaxis only
B) Pharmacological prophylaxis only
C) Combined pharmacological and mechanical prophylaxis
D) Early ambulation only
Correct Answer: C
Rationale: Daily VTE risk assessment with validated tools is mandatory, with pharmacological combined with mechanical prophylaxis for very high-risk patients 3.
Question 9: Robotic-Assisted Laparoscopic Myomectomy
How do outcomes of robotic-assisted laparoscopic myomectomy compare to traditional laparoscopy?
A) Longer operative time with more complications
B) Shorter operative time with fewer complications
C) Similar operative time, hospital stay, and postoperative complications
D) Shorter hospital stay but longer operative time
Correct Answer: C
Rationale: Outcomes of robotic-assisted laparoscopic myomectomy appear similar to traditional laparoscopy in terms of operative time, hospital stay, and postoperative complications 1. Laparoscopic myomectomy is associated with shorter hospital stays and faster return to usual activities compared to open myomectomy 3.
Question 10: Combined Hysteroscopy and Laparoscopy
What is the primary advantage of performing laparoscopic monitoring during hysteroscopic procedures?
A) Reduced operative time
B) Detection of uterine perforation
C) Improved visualization of fibroids
D) Decreased postoperative pain
Correct Answer: B
Rationale: Two cases of uterine perforation were found by laparoscopic monitoring during hysteroscopic procedures 2. Operations using combination of hysteroscopy and laparoscopy are safe and effective, and laparoscopic monitoring may detect uterine perforation in time 2.