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Trocar-related abdominal wall bleeding in 200 patients after laparoscopic cholecistectomy: Personal experience
Girolamo Geraci1, Carmelo Sciume, Franco Pisello
1University of Palermo, Section of General and Thoracic Surgery via Carmelo Trasselli n. 16-90129, Palermo, Sicily, Italy. girgera@tin.it
Aim:
To determine the complications and incidence of the first and second access-related vascular injuries induced by videolaparoscopic cholecistectomy.
Methods:
We retrospectively reviewed vascular injuries in 200 consecutive patients who underwent videolaparoscopic cholecistectomy from 2003 to 2005. One hundred and one patients with placement of radial expanding trocars were assigned into group A and 99 patients with placement of pyramidal tipped trocars into group B. All the patients were submitted to open access according to Hasson for the first trocar.
Results:
Bleeding did not occur at the intraoperative cannula-site in group A. However, it occurred at the intraoperative cannula-site of 7 patients (7.1%) in group B, with a statistically significant difference (P < 0.01). No mortality was registered. More vascular lesions were found in group B.
Conclusion:
The advantage of Hasson technique is that peritoneal cavity access is gained under direct vision, preventing most severe injuries. The open technique with radial expanding trocars is recommended for secure access to the abdominal cavity in videolaparoscopy. Great care should be taken to avoid major complications and understanding the abdominal wall anatomy is important for reducing bleeding during or after s placement of trocars.