Avoiding Major Vessel Injury During Laparoscopic Instrument Insertion Stephanie D. Pickett, MD a , Katherine J. Rodewald, MD a , Megan R. Billow, DO a , Nichole M. Giannios, DO a , William W. Hurd, MD, MSc b,c, * Laparoscopy is one of the most common surgical approaches performed in the United States today. This surgical approach has gained popularity compared with traditional laparotomy due to increased safety, better outcomes, and shorter recovery periods. Each year gynecologists and general surgeons perform an estimated 2 million laparo- scopic procedures, including cholecystectomies, tubal ligations, appendectomies, hysterectomies, urogynecologic repairs, and cancer staging, to name a few. 1 Advances in laparoscopic technology and the development of robotic surgery are likely to further increase the number of cases performed laparoscopically. Fortunately, major complications related to laparoscopy are uncommon, occurring in less than 2% of procedures. 2 One of the most serious laparoscopic complications is injury to major vessels, which reportedly occurs in approximately 0.04% of cases. 3 Vessel injury occurs most commonly while gaining intra-abdominal access during insertion of the Veress needle and port trocars through the abdominal wall. 2,4 Although vessel injury occurrence is low, mortality is high. Injury to one or more major vessels can quickly result in fatal exsanguinations, with a majority of these deaths occurring within the first 24 hours The authors have nothing to disclose. a Department of Obstetrics and Gynecology, University Hospitals Case Medical Center, 11100 Euclid Avenue MAC 5034, Cleveland, OH 44106, USA b Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University Hospitals Case Medical Center, 11100 Euclid Avenue MAC 5034, Cleveland, OH 44106, USA c Department of Reproductive Biology, Case Western Reserve University School of Medicine, 11100 Euclid Avenue MAC 5034, Cleveland, OH 44106, USA * Corresponding author. E-mail address: William.Hurd@uhhospitals.org KEYWORDS  Laparoscopy  Intraoperative complications  Blood vessel injuries Obstet Gynecol Clin N Am 37 (2010) 387–397 doi:10.1016/j.ogc.2010.05.002 obgyn.theclinics.com 0889-8545/10/$ – see front matter ª 2010 Elsevier Inc. All rights reserved.