Avoiding Major Vessel Injury During Laparoscopic Instrument Insertion

Gynecologic Laparoscopy

“…It is recommended that at least one of these methods be used when placing a Veress needle into the abdomen [ 53 ] . However, none of these methods absolutely verify intraperitoneal placement of the needle tip.…”

“…Unfortunately, this technique might increase this risk of major vessel injury. Large series (>10,000 cases) report a major vessel injury risk of 0.06-0.09 % compared to 0.04 % using a standard closed technique [ 53 ] . This risk of major vessel injury might be one reason why direct trocar insertion is one of the least frequently used techniques by gynecologists.…”

“…Alternative primary trocars have been developed, including shielded disposable trocars, optical trocars, and radially expanding trocars [ 53 ] . Unfortunately, their use does not prevent major blood vessel injuries.…”

“…In these instances, a laparoscopic surgeon without experience in vascular surgery should not attempt to open the retroperitoneal area to repair the vessel [ 53 ] . This approach can further injure the vessels, and resultant lack of circulation to the lower extremities can have catastrophic results.…”

The Effect of Age and Body Mass Index on the Surgical Anatomy of Supraumbilical Port Insertion: Implications for Laparoscopic and Robotic Surgery

“…Injury to the aorta, right common iliac artery, left common iliac vein, or inferior vena cava (IVC) occurs in 0.04% of laparoscopic cases [1-3] and predominantly occurs during initial trocar entry at the beginning of a minimally invasive procedure [4]. Naturally, a Veress or trocar that penetrates too deep may intersect with the significant focus of critical vessels in the abdomen that originate from the divergence of the descending aorta and IVC.…”