title: A simple technique for anticipating and managing secondary puncture site hemorrhage during laparoscopic surgery. A report of two cases.
abstract: BACKGROUND
  Clinically significant hemorrhage from secondary port sites at laparoscopy is an uncommon but serious complication and can go unrecognized intraoperatively.
  
  
  METHODS
  A 28-year-old woman undergoing operative laparoscopy sustained abdominal wall vessel injury and required a blood transfusion. A second patient received the same injury but, when the author's technique was used, had minimal blood loss and a benign postoperative course. With this technique, a blunt instrument is placed through the sheath and into the peritoneal cavity before any secondary port is removed. The sheath is withdrawn, only the probe is kept in the abdomen, and then hemorrhage usually becomes evident.
  
  
  CONCLUSIONS
  A new technique aids the diagnosis of occult abdominal vessel injury and allows rapid recanalization of the secondary trocar sheath paths.
authors.affiliation: Department of Obstetrics and Gynecology, Kaiser Permanente Medical Center, San Francisco, California 94115-3394, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Lewis
mesh_terms: D000328:Adult; D005260:Female; D006488:Hemostasis, Surgical / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000009:adverse effects*; D009765:Obesity / Q000150:complications; D017699:Pelvic Pain / Q000150:complications / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control*