Fundamentals of Endoscopic Surgery (FES) Written Practice Exam

Applying pressure during biliary sphincterotomy is essential for successful cannulation and to effectively manage any resistance that may occur. In this procedure, directing pressure toward the 11 o'clock direction is optimal because this positioning helps to lift the ampulla of Vater and provides better access to the common bile duct.

This technique facilitates the entry of instruments through the duodenum and aligns the sphincterotomy with the anatomy of the biliary system, ensuring that the process is effective. Proper placement of pressure in this direction minimizes the risk of complications and enhances the likelihood of successful ductal access.

In contrast, applying pressure in other directions may not achieve the same anatomical alignment or could create unnecessary complications. For instance, directing pressure toward the 3 o'clock position may impede access rather than facilitate it, while directing it directly toward the common bile duct can risk injury to surrounding structures. Similarly, pressure towards the patient's feet is not anatomically conducive during this type of procedure.

In summary, utilizing the 11 o'clock direction during biliary sphincterotomy maximizes access and safety, aligning with the intraoperative anatomical considerations critical for a successful outcome.