During laparoscopy:
Avoid / prevent:
- Use smallest ports appropriate
- Transillumination of body wall and visualisation from within abdomen
- Angle trochars away from midline
- Use local needle to identify port placement prior to inserting trochar
- > 6 cm from midline should generally be safe
Techniques for control
- Direct pressure by ‘torquing’ on the port against the rectus to tamponade bleeding
- Extend port incision for visualisation and direct suture ligation
- Intracorporeal suture ligation with Carter-Thommason needle (port closure needle) or Keith needle
- IDC through port with balloon inflated and pulled back to abdominal wall for tamponade for 24 – 48 hours
- IR embolisation
Delayed rectus sheath haematoma – preferred observation if stable or IR embolisation if unstable/anaemia/anticoagulated – surgical disruption/drainage will lose all tamponade