title: Avoiding major vessel injury during laparoscopic instrument insertion.
abstract: Major vessel injuries during laparoscopy most commonly occur during insertion of Veress needle and port trocars through the abdominal wall. This article reviews methods for avoiding major vessel injury while gaining laparoscopic access, including anatomic relationships of abdominal wall landmarks to the major retroperitoneal vessels. Methods for periumbilical placement of the Veress needle and primary trocar are reviewed in terms of direction and angle of insertion, and alternative methods and locations are discussed. Methods for secondary port placement are reviewed in terms of direction, depth, and speed of placement.
authors.affiliation: Department of Obstetrics and Gynecology, University Hospitals Case Medical Center, 11100 Euclid Avenue MAC 5034, Cleveland, OH 44106, USA.
authors.forename: Stephanie D
authors.initials: SD
authors.lastname: Pickett
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Rodewald
authors.forename: Megan R
authors.initials: MR
authors.lastname: Billow
authors.forename: Nichole M
authors.initials: NM
authors.lastname: Giannios
authors.forename: William W
authors.initials: WW
authors.lastname: Hurd
mesh_terms: D001013:Aorta, Thoracic / Q000293:injuries; D001808:Blood Vessels / Q000293:injuries*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D007083:Iliac Artery / Q000293:injuries; D007084:Iliac Vein / Q000293:injuries; D007431:Intraoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D009339:Needles; D009765:Obesity; D050177:Overweight; D013525:Surgical Instruments; D014684:Venae Cavae / Q000293:injuries