Management of hemorrhage during laparoscopy.

Bleeding can be a complication of laparoscopic procedures commonly performed by urologists, such as pelvic node dissection and nephrectomy, and is often difficult to manage. Hemorrhage also can occur as a result of Veress needle or trocar placement, and there are specific strategies for the management of these injuries. Laparoscopic clip appliers, laparoscopic staplers, laparoscopic suturing, various energy sources (monopolar and bipolar electrocautery, laser, ultrasonic dissectors, and argon beam coagulators), and topical agents (gelatin foam, cellulose, collagen, and fibrin sealant) can be used to obtain hemostasis. Converting to laparotomy to obtain hemostasis may be necessary in some cases. Proper patient selection is important for lowering the risk of hemorrhage.