Diagnostic and Operative Gynaecological Laparoscopy, Hysteroscopy, and Minimally Invasive Surgery — WACS Viva & Clinical Scenarios (Gynaecology)

Exam-style diagnostic and operative gynaecological laparoscopy, hysteroscopy, and minimally invasive surgery viva scenarios with examiner probes and model…

Scenarios covered

• SCENARIO 1: A 34-year-old woman is undergoing elective total laparoscopic hysterectomy (TLH) for symptomatic adenomyosis. Ten minutes after peritoneal CO2 insufflation at 15 mmHg and placement into 30-degree steep Trendelenburg, peak airway pressure rises from 18 to 36 cmH2O, EtCO2 increases to 58 mmHg, and SpO2 drops from 99% to 92%. Describe your immediate differential diagnosis and step-by-step management.
• SCENARIO 2: During laparoscopic adhesiolysis for pelvic pain in a 28-year-old woman, the surgeon inserts the secondary trocar into the left lower quadrant. Immediately, the patient becomes profoundly hypotensive (BP 55/30 mmHg) with sudden tachycardia (HR 145 bpm) and rapidly decreasing EtCO2. Detail your acute crisis management protocol.
• SCENARIO 3: A 42-year-old woman is undergoing hysteroscopic resection of a large submucous fibroid under general anaesthesia with non-conductive 1.5% glycine distension medium. After 50 minutes of surgery, fluid balance reveals a 1500 mL deficit. The patient develops bradycardia, hypertension followed by hypotension, and ST-segment depression on ECG. Outline your diagnosis, acute intervention, and postoperative neurological management.
• SCENARIO 4: A 29-year-old nulliparous woman is booked for day-case diagnostic laparoscopy and chromopertubation (methylene blue dye test) for primary infertility. Discuss your anaesthetic technique, airway selection, prevention of postoperative nausea and vomiting (PONV), and management of potential methylene blue dye artefacts.