Exxcellence pearls: avoiding trocar injuries at laparoscopic surgery

Question 0

Describe the course of the major vessels that could be encountered during laparoscopic entry.

Answer 0

Desending aorta, common iliac, internal and external iliac. Before the external iliac enters the inguinal canal, the inferior epigastrics branch anteriorly and travel through the transversalis fascia and then between the rectus abdominis and the posterior lamellar sheath.

Question 1

The majority of injuries during laparoscopy occur at what time?

What region of the bowel is at highest risk of injury?

Answer 1

Surgical entry

Small intestine

Question 2

What position should be avoided during Veress needle insertion?

Answer 2

Trendelenburg

Question 3

And non-obese women, insertion of the Veress needle at the umbilicus encounters what abdominal wall thickness?

What is the average distance to major vessels?

Answer 3

2-3 cm

6-10 cm

Question 4

What are the two “clicks” heard at Veress needle insertion?

Answer 4

Anterior rectus sheath and through the peritoneum

Question 5

What tests can be done to confirm intra-abdominal Veress needle placement?

Answer 5

Waggle test, hanging drop a test

Question 6

What is the placement of left upper quadrant insertion?

Answer 6

Placement at Palmer’s point.

Question 7

When landmarks are not visible laparoscopically, what external site may be used?

Answer 7

5 cm superior to the mid pubic symphysis and 8 cm lateral from the midline.