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Major blood vessel injury is a true emergency during laparoscopic procedures. Too often, the act or fear of litigation quashes the opportunity to assess the cause and learn from the experience of others. Frequently, only through a medicolegal review can such events be evaluated. After reviewing 40 such cases, the following lessons were learned. Proper technique when inserting the Veress needle, laparoscopic cannulas, and open cannulas can prevent most such accidents. If the standard precautions during insertion are breached, safety shields on disposable cannula sleeves do not prevent or reduce the risk of major vessel injury. Retroperitoneal hematomas require exploratory laparotomy for proper assessment. Distorted anatomy or steep Trendelenburg position may increase the risk of vessel injury. Dissections around the great vessels of the pelvis require the same methods and precautions as with laparotomy.

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