Trocar injury of abdominal wall vessels: a simple method to stop the haemorrhage

BACKGROUND

Misplaced laparoscopic ports can lead to brisk bleeding from traumatised abdominal wall vessels, with a reported incidence of 0.15%.¹ Significant blood loss may occur until definitive haemostasis is achieved. We describe a simple temporising measure to stop the bleeding, allowing a calm approach for a definitive repair.

TECHNIQUE

The original port is removed and a Kii® GelPort® balloon trocar (Applied Medical UK Ltd, London EC2N 1HQ) is introduced through the same incision. The internal balloon is inflated with air and the external gel seal bolster is locked tight against the skin surface (Fig 1). This unique port allows compression of the vessel against two static surfaces and leads to arrest of bleeding through direct compression. When the bleeding is under control, the vessel can be ligated by extracorporeal or intracorporeal suturing, open cut-down and ligation or more novel methods such as angiographic embolisation.²

Figure 1.

Kii® GelPort® balloon trocar: internal balloon (A), external gel seal bolster (B)

DISCUSSION

Planned and careful trocar placement can reduce the incidence of this complication. It is therefore advisable to place lateral ports lateral to the rectus, visualise superficial vessels by transillumination of the skin and deep vessels by direct laparoscopic inspection. Nevertheless, injuries to vessels do occur. This method affords you enough time to make a definitive repair without significant blood loss. An alternative would be to use the balloon of a Foley catheter; however, it will only allow compression against one surface and may not be as effective.