Miscellaneous Laparoscopic Surgery

Bleeding can be a complication of laparoscopic procedures, such as, pelvic node dissection or nephrectomy and is often difficult to manage. Vascular injury can be prevented by use of trocars with safety devices and use of the Hasson trocar (open technique) to achieve pneumoperitoneum. Laparoscopic clip applicators, including curved endoclips, laparoscopic staplers, laparoscopic suturing, various energy sources (monopolar and bipolar electrocautery, laser, ultrasonic dissectors, and argon beam coagulators), and topical agents (gelatin foam, cellulose, collagen, and fibrin sealant) can be used to achieve haemostasis, although in some cases it may be necessary to convert to laparotomy to stop the bleeding.74

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