Surgical Endoscopy

, Volume 15, Issue 3, pp 275–280 | Cite as

Trocar and Veress needle injuries during laparoscopy

  • M. Schäfer
  • M. Lauper
  • L. Krähenbähl
Original article



Inadvertent lesions of the intraabdominal organs and vessels caused by trocars and Veress needles are rare but serious complications of laparoscopic surgery. Establishing the pneumoperitoneum is believed to be the most dangerous step.


The Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTS) prospectively collected the data on 14,243 patients undergoing various standard laparoscopic procedures between 1995 and 1997. This database was investigated with special regard to intraabdominal complications caused by trocars and Veress needles.


There were 22 trocar and four needle injuries (incidence, 0.18%). Nineteen lesions involved visceral organs; the remaining seven were vessel injuries. The small bowel was the single most affected organ (six cases), followed by the large bowel and the liver (three cases each). All vascular lesions, except for one laceration of the right iliac artery, occurred as venous bleeding of either the greater omentum or the mesentery. Fourteen trocars were inserted under direct vision. Nineteen trocar injuries were recognized intra-operatively; diagnoses of two small bowel and one bladder injuries were made postoperatively. Needle injuries were all diagnosed intraoperatively. Only five injuries could be repaired laparoscopically; the remaining lesions were repaired openly. Four patients underwent an open reoperation, and another patient needed five reoperations. There was one death (4.0%).


Trocar and needle injuries are rare complications of laparoscopy. However, if not recognized intraoperatively and repaired immediately, they induce increased morbidity and mortality. Both open and closed establishment of the pneumoperitoneum are related to a potential danger of perforating lesions, but inserting the first trocar under direct vision allows early recognition and immediate repair.

Key words

Laparoscopy Complications Trocar Veress needle Open vs closed Pneumoperitoneum Prospective study 


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  1. 1.
    Bailey IS, Rhodes M, O’Rourke N, Nathanson L, Fielding G (1998) Laparoscopic management of acute small bowel obstruction. Br J Surg85: 84–87PubMedCrossRefGoogle Scholar
  2. 2.
    Ballem RV, Rudomanski J (1993) Techniques of pneumoperitoneum. Surg Laparosc Endosc 3: 42–43PubMedGoogle Scholar
  3. 3.
    Bonjer HJ, Hazebroek EJ, Kazemier G, Giuffrida MC, Meijer WS, Lange JF (1997) Open versus closed establishment of pneumoperitoneum in laparoscopic surgery. Br J Surg 84: 599–602PubMedCrossRefGoogle Scholar
  4. 4.
    Byron JW, Markenson G, Miyazawa K (1993) A randomized comparison of Verres needle and direct trocar insertion for laparoscopy. Surg Gynecol Obstet 177: 259–262PubMedGoogle Scholar
  5. 5.
    Champault G, Cazacu F, Taffinder N (1996) Serious trocar accidents in laparoscopic surgery: a French survey of 103,852 operations. Surg Laparosc Endosc 6: 367–370PubMedCrossRefGoogle Scholar
  6. 6.
    Deziel DJ, Millikan KW, Economou SG, Doolas A, Ko ST, Airan MC (1993) Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77.604 cases. Am J Surg 165: 9–14PubMedCrossRefGoogle Scholar
  7. 7.
    Hanney RM, Carmalt HL, Merrett N, Tait N (1999) Use of the Hasson cannula producing major vascular injury at laparoscopy. Surg Endosc 13: 1238–1240 DOI: 10.1007/s004649901235PubMedCrossRefGoogle Scholar
  8. 8.
    Hanney RM, Carmalt HL, Merrett N, Tait N (1999) Vascular injuries during laparoscopy associated with the Hasson technique. J Am Coll Surg 188: 337–338PubMedCrossRefGoogle Scholar
  9. 9.
    Hashizume M, Sugimachi K (1997) Needle and trocar injury during laparoscopic surgery in Japan. Surg Endosc 11: 1198–1201 DOI: 10.1007/s004649900568PubMedCrossRefGoogle Scholar
  10. 10.
    Hasson HM (1971) A modified instrument and method for laparoscopy. Am J Obstet Gynecol 110: 886–887PubMedGoogle Scholar
  11. 11.
    Mac CC, Lecuru F, Rizk E, Robin F, Boucaya V, Taurelle R (1999) Morbidity in laparoscopic gynecological surgery: results of a prospective single-center study. Surg Endosc 13: 57–61 DOI: 10.1007/S004649900898CrossRefGoogle Scholar
  12. 12.
    Nezhat FR, Silfen SL, Evans D, Nezhat C (1991) Comparison of direct insertion of disposable and standard reusable laparoscopic trocars and previous pneumoperitoneum with Veress needle. Obstet Gynecol 78: 148–150PubMedGoogle Scholar
  13. 13.
    Reddick EJ, Olsen DO (1989) Laparoscopic laser cholecystectomy: a comparison with mini-lap cholecystectomy. Surg Endosc 3: 131–133PubMedCrossRefGoogle Scholar
  14. 14.
    Reich H (1992) Laparoscopic bowel injury. Surg Laparosc Endosc 2: 74–78PubMedGoogle Scholar
  15. 15.
    Sadeghi-Nejad H, Kavoussi LR, Peters CA (1994) Bowel injury in open technique laparoscopic cannula placement. Urology 43: 559–560PubMedCrossRefGoogle Scholar
  16. 16.
    Sigman HH, Fried GM, Garzon J, Hinchey EJ, Wexler MJ, Meakins JL, Barkun JS (1993) Risks of blind versus open approach to celiotomy for laparoscopic surgery. Surg Laparosc Endosc 3: 296–299PubMedGoogle Scholar
  17. 17.
    Wherry DC, Marohn MR, Malanoski MP, Hetz SP, Rich NM (1996) An external audit of laparoscopic cholecystectomy in the steady state performed in medical treatment facilities of the Department of Defense. Ann Surg 224: 145–154PubMedCrossRefGoogle Scholar
  18. 18.
    Woolcott R (1997) The safety of laparoscopy performed by direct trocar insertion and carbon dioxide insufflation under vision. Aust N Z J Obstet Gynaecol 37: 216–219PubMedCrossRefGoogle Scholar
  19. 19.
    Zaraca F, Catarci M. Gossetti F, Mulieri G, Carboni M (1999) Routine use of open laparoscopy: 1,006 consecutive cases. J Laparoendosc Adv Surg Tech A 9: 75–80PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2001

Authors and Affiliations

  • M. Schäfer
    • 1
    • 2
  • M. Lauper
    • 1
  • L. Krähenbähl
    • 1
    • 2
  1. 1.Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTS)Aarberg HospitalAarbergSwitzerland
  2. 2.Department of Visceral and Transplantation SurgeryUniversity of Zürich, RamistrasseZürichSwitzerland

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