Major Vascular Injury During Laparoscopy: Pearls to Cope. Milad M. April 2008:62-68 • This surgical techniques article presents a case of “Trocar Insertion, Then a Bleed” in a 29-year-old nulliparous patient undergoing diagnostic laparoscopy. Milad notes that gynecologic laparoscopy has a rate of major complication similar to that of laparotomy and a higher rate of major vascular injury. How to avert and handle this type of injury is further discussed with Milad detailing (including diagrams) the following 5 pearls:
(1) Pay attention to subtlety, starting at the preop visit; consider the patients height, weight, BMI, and surgical history.
(2) Don’t undervalue that ounce of prevention: select an entry technique wisely, tips to facilitate entry, no single trocar is fail-safe.
(3) Don’t be the king or queen of denial. A major vascular injury should immediately be suspected when a retroperitoneal hematoma or brisk bleeding is visualized.
(4) No man is an island. Get help when you need it.
(5) Identify, secure, and control the site of injury: laparoscopy is usually not an option, a vertical skin incision is best, control the bleeding, repair the laceration.