Navigating Vascular Injuries in Laparoscopic Surgery: A Comprehensive Guide – ARC Summit

Next, we’ll discuss vascular injuries in laparoscopic surgery, which can occur from bleeding in the abdominal wall. It’s essential to know the anatomy of your blood vessels, as injuries can happen intraperitoneally—like with the mesenteric and uterine arteries—or more seriously, with retroperitoneal vessels during trocar insertion.

One critical practice is to always insert secondary trocars under direct visualization. Failure to do so is indefensible legally, as this is when most severe vascular injuries occur. The two key vessels at risk on the abdominal wall are the inferior epigastric and the superficial epigastric arteries. The inferior epigastric artery, located on the inner part of the abdominal wall, can be seen with the laparoscope, typically appearing as one artery flanked by two veins. The superficial epigastric artery can be identified by transillumination, unlike the inferior epigastric artery.

If you inadvertently cause bleeding from these vessels, the situation can quickly become severe. Effective methods to control this bleeding include using a large needle to suture both above and below the injury site or employing modern suture passers, like the CED Thomason, to secure the vessel. Simply inflating a Foley catheter through the trocar and pulling it back—an older method—rarely works effectively.

In cases where these measures are applied, the patient may experience significant hematomas but should stabilize properly with these interventions.