Gynecologic Surgery — MCQs

A 67-year-old woman with endometrial cancer undergoes robotic-assisted staging surgery. Final pathology reveals grade 2 endometrioid adenocarcinoma with 60% myometrial invasion, positive pelvic lymph nodes (2/15), negative para-aortic nodes (0/8), and lymphovascular space invasion. No cervical or adnexal involvement. The tumor care team debates adjuvant treatment. Evaluate which combination of pathologic features most significantly impacts treatment recommendations?

A 29-year-old woman with stage IA1 cervical cancer (3 mm invasion, no LVSI) desires fertility preservation. She has one child and wants more children. Cone biopsy margins are positive. Imaging shows no lymph node involvement. Her oncologist recommends radical hysterectomy, while a fertility specialist suggests radical trachelectomy. The patient strongly desires future pregnancy. Evaluate the optimal management strategy balancing oncologic and reproductive outcomes.

A 42-year-old woman with BMI 42 kg/m² and abnormal uterine bleeding undergoes robotic-assisted total laparoscopic hysterectomy. Intraoperatively, she requires steep Trendelenburg positioning for 180 minutes. Postoperatively, she develops dyspnea, hypoxemia, and facial edema. Chest X-ray shows pulmonary edema. Evaluation of her postoperative course requires synthesis of which pathophysiologic mechanisms?

A 35-year-old woman with BRCA1 mutation presents for risk-reducing bilateral salpingo-oophorectomy. She has completed childbearing and wants to minimize cancer risk. Preoperatively, her CA-125 is normal and transvaginal ultrasound shows normal ovaries. During surgery, the right ovary appears irregular with a 2 cm solid area. Frozen section shows borderline serous tumor. Analysis of treatment options must consider which factor most significantly?

A 48-year-old woman with uterine prolapse undergoes vaginal hysterectomy with anterior and posterior colporrhaphy. During the procedure, while developing the bladder flap, the surgeon notices immediate filling of the surgical field with clear fluid. A 1 cm bladder injury is identified at the dome. Analysis of this complication reveals it occurred due to which anatomical relationship?