Module 12

Question 1

Initial approach to hemorrhage

Answer 1

• Optimize visualization: clean scope and port, or change port if needed
• Grasp and hold bleeding source: can also apply pressure with gauze pad
• Maintain exposure: suction irrigator; may need to add port to use additional instrument
• Identify bleeding source: may need further dissection

** If cannot maintain hemodynamic stability, may need to promptly convert to open surgical techniques

Question 2

how do you deal with external port site bleeding?

Answer 2

Caused by scalpel or trocar
May be in skin, subQ vessel, or muscle
Can use electrocautery or sutures
May need to extend skin incision

Question 3

What do you do if your internal port site bleeding?

Answer 3

• remove port under direct visualization
• highest risk is injury to inferior epigastric vessels (do not want to be in rectus muscles)

*Control source of bleed with electrocautery
*Consider clamp and the suture ligation, clamp, or energy source
*Can use foley bulb to get temporary control
*Consider full thickness abdominal wall sutures

Question 4

what can cause retroperitoneal bleeding?

Answer 4

Veress needle: may have overlying viscera, may be in mesentery of bowel, may have concomitant injury

Trocar injury: More immediate blood loss and more easily diagnosed; require urgent open exploration and mgmt

Tx: attempt to control laparoscopically, otherwise laparotomy and consult if needed

Question 5

s/s of RP bleeding

Answer 5

RP hematoma
mesenteric hematoma
free blood
hypovolemic shock

Question 6

what size vessels require monopolar vs. bipolar energy?

Answer 6

mono - small
bi - larger

Question 7

Pros and Cons of Clips

Answer 7

Pro: Rapid, single hand application

Con: May be dislodged easily, may hinder future applications to control bleeding

Question 8

Options for larger vessel ligation

Answer 8

Requires dissection
Proper suture ligation
Appropriate energy source
Can use vascular stapler