To perform safe and effective laparoscopic surgery, the surgeon must be well-trained in both basic and advanced surgical procedures as well as in laparoscopic techniques. Furthermore, modern equipment should be available in the surgical unit. Compared with conventional open surgery, all these devices are accompanied with long application times. Unfortunately, there is no instrument that is ideal for all kinds of bleeding problems. The endoscopic surgeon should be familiar with several tools for haemostasis. All of these devices are not necessary, but a particular set of instruments should be available in a surgical department experienced in performing laparoscopic surgery. Most of them are disposable instruments. In times of limited resources it is necessary to decide carefully, which of these tools is the most effective one for the patient and the most potent for the future development of laparoscopic surgery.
Future options in laparoscopic surgery to control major bleeding and loss of gas during suction are possibly, hand-assisted laparoscopic surgery and gasless laparoscopy.20
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