Bleeding:
- To keep the surgical field clear in case of bleeding, irrigate and suction first because this improves the view in the filed and allows precise identification of the source of the bleeder. If the bleeder needs clipping, replace the 5 mm trocar by a 10 mm trocar. When visual control is poor, it is always possible to insert another 5 mm/10 mm trocar to better explore the surgical field.
- If these measures do not yield the desired results the operation must be converted to an open procedure.
Pneumoperitoneum:
- Quite often the gas will also insufflate the abdominal cavity which narrows the preperitoneal workspace somewhat. Usually this does not hinder further dissection. If needed, insertion of a Veress needle will deflate the abdominal cavity and reestablish sufficient workspace. If it is not possible to create enough workspace this way, it is always possible to convert to a TAPP procedure.
Larger peritoneal defects:
- Larger peritoneal defects should be sutured or clipped to stop the mesh from getting into contact with the intraabdominal organs.