Laparoscopic Hemorrhage: Do We Have to Open?
You’re dissecting Calot’s triangle during a routine elective cholecystectomy. Sure, the patient is rather large, but you’ve done this dissection hundreds of times before without breaking a sweat. This time, however, as you spread your Maryland dissector to clear some remaining tissue just medial to the cystic artery, the blood begins to spill at a shockingly rapid rate. You immediately feel a sick sensation in the pit of your gut.
Instinctively, you grab your 5 mm suction irrigator to evacuate some of the blood, but the suction immediately becomes clogged. You press the irrigation button to force the clot from the suction catheter, but this only causes more fluid to spill into the surgical field, further obscuring your view. As more blood spills, the image on the monitor begins to dim as the blood absorbs the light. You ask for a 4 × 4 Ray-Tec© gauze to help mop up the mess, but when you try to insert it into the abdomen, you realize that it won’t fit through any of the tiny 5 mm trocars. You ask for a 10 mm trocar, but there aren’t any in the room. Now, with a slightly raised voice, you ask for the 5 mm clip applier instead. As you insert the instrument, a spurt of blood splashes across the camera lens—lights out. You quickly clean and reinsert the camera, but the patient begins to buck. As you yell to the anesthesia team to administer more paralytic agent, the camera gets smudged yet again. The nurse anesthetist informs you that the patient’s blood pressure is dropping precipitously. Realizing the gravity of the situation, you finally decide to cut your losses and convert to a laparotomy. You yell to the scrub nurse for a scalpel, but, as you glance over, you realize she only has a tiny #11 scalpel blade on the set.