Hans Henning Noelcke Christina Franke and Karl J Oldhafer

"Blood saving is better than blood transfusion!"

W. Schmitt (1968)1

Among intra- and postoperative complications, bleeding represents one of the most serious problems for patients after laparoscopic surgery.2 Endoscopic surgeons must be trained to recognise, avoid and, if necessary, manage bleeding complications. Over the last decade, novel techniques have been developed to make haemosta-

sis in minimal access surgery as efficient and reliable as in open 3-- 8

surgery.3 8

Although the technically advanced video-endoscopy provides a better view, including magnification, it can compensate only partially for the lack of direct manual control. Most importantly, major bleeding causes several problems in laparoscopic surgery. In these cases, immediate compression by a laparoscopic instrument or control by surgeon's hand remains difficult. In addition, suction under laparoscopic conditions makes detection of the bleeding blood vessel troublesome, as gas distension of the abdominal cavity is simultaneously reduced.

Therefore, bleeding complications in minimal access surgery require highly trained teams and several tools for bleeding control. The surgeon should be experienced in endoscopic surgery following the fundamental principle primum nil nocere and familiar with the decision to change to open surgery.

To avoid bleeding or to achieve haemostasis in laparoscopic surgery basic instruments and techniques, special equipment, and local haemostyptica are needed.

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