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[[Category: Surgical Education and Training]]

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Under construction 18 02 2008





==Basic laparoscopy: Cholecystectomy 07.30.01 Dealing with bleeding==




'''If you meet bleeding.'''


Blood on the telescope.

[[Image:07.30.00_blood_on_the_telescope.jpg]]


Identify the cause of the bleeding and respond as described below.


The camera magnifies the bleeding alarmingly.


Don't panic.

[[Image:07.30.00_dealing_with_bleeding.jpg]]


Try local pressure with the hook electrode for 2 minutes.


Use pressure with a pledget held in a racquet diathermy forcep for 2 minutes.


Connect the diathermy forcep to the diathermy machine.


Put the suction/irrigator in the subcostal port.


Put the diathermy forcep in the epigastric port.


Grasp a 1-2mm. vessel precisely with forcep and coagulate it.


Grasp a larger vessel with the forcep and wait for 3 minutes to allow spontaneous coagulation.


Dissect out a vessel held in the forcep to allow clipping.


Wait 10 minutes before deciding on an open operation.


For uncontrollable bleeding, do a laparotomy.
 

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