Major vessel injury at laparoscopic entry — emergency management station

Team-based emergency station: major retroperitoneal vessel injury at laparoscopic entry in a thin, previously-operated patient. Tests parallel resuscitation, the damage-control versus definitive-repair decision, closed-loop communication, and escalation to a vascular surgeon. Includes assessor key and marking domains.

Prompt

A 26-year-old with a body mass index of 18 and a previous midline laparotomy for trauma is having a diagnostic laparoscopy for pelvic pain. You have just performed a closed umbilical Veress entry. As the primary trocar goes in, the anaesthetist reports a falling blood pressure, the field fills with dark blood, and a retroperitoneal haematoma is expanding. The consultant is in clinic, 10 minutes away.

Station brief

Format. Emergency management station, approximately 12 minutes. You are the gynaecology registrar in theatre. A scrub nurse and an anaesthetist are with you; the consultant is 10 minutes away and has been called. The assessor runs the clock and feeds new observations. ^[3]

Candidate instruction. Lead the management of a suspected major vessel injury at laparoscopic entry. Verbalise your actions, your escalation triggers, your communication with the team and the consultant, and your decision between damage control and definitive repair. ^[3]

References4Show

[1]Ahmad G, Baker J, Finnerty J, Phillips K, Watson A Laparoscopic entry techniques Cochrane Database Syst Rev, 2019.PMID 30657163
[2]Granata M, Tsimpanakos I, Moeity F, Magos A Are we underutilizing Palmer's point entry in gynecologic laparoscopy? Fertil Steril, 2010.PMID 20452584
[3]Sandadi S, Johannigman JA, Wong VL, Blebea J, Altose MD, Hurd WW Recognition and management of major vessel injury during laparoscopy J Minim Invasive Gynecol, 2010.PMID 20656569
[4]Wind J, Cremers JE, van Berge Henegouwen MI, Gouma DJ, Jansen FW, Bemelman WA Medical liability insurance claims on entry-related complications in laparoscopy Surg Endosc, 2007.PMID 17410401

Major vessel injury at laparoscopic entry — emergency management station

Station brief

References4Show

[1]Ahmad G, Baker J, Finnerty J, Phillips K, Watson A Laparoscopic entry techniques Cochrane Database Syst Rev, 2019.PMID 30657163
[2]Granata M, Tsimpanakos I, Moeity F, Magos A Are we underutilizing Palmer's point entry in gynecologic laparoscopy? Fertil Steril, 2010.PMID 20452584
[3]Sandadi S, Johannigman JA, Wong VL, Blebea J, Altose MD, Hurd WW Recognition and management of major vessel injury during laparoscopy J Minim Invasive Gynecol, 2010.PMID 20656569
[4]Wind J, Cremers JE, van Berge Henegouwen MI, Gouma DJ, Jansen FW, Bemelman WA Medical liability insurance claims on entry-related complications in laparoscopy Surg Endosc, 2007.PMID 17410401