Management of Laparoscopic Trocar Injuries to Anterior Abdominal Wall Blood Vessels

The incidence of trocar injuries of vessels at the anterior abdominal wall has been reported to be approximately two percent. Knowledge of the anatomy, landmarks, and intra-operative laparoscopic identification (for example, transillumination) may assist in avoidance of these injuries. Prior to the withdrawal of the laparoscope, removing all trocars under direct vision and slowly decreasing the intra-abdominal pressure by allowing gradual escape of the carbon dioxide will allow the surgeon to identify any trickling of blood from trocar sites. Mechanical tamponade with a Foley catheter, gauze through the trocar site, electrocoagulation (internal or external cauterization under laparoscopic vision), or direct ligation of the bleeding vessel using a variety of techniques (laparoscopic sealing devices, hemostasis with open surgery, and hemostatic patches) will ensure that the patient will not be exposed to increased associated morbidity from a laparoscopic procedure.