Problem:

Solutions:

Best solution:

1. Riza-Ribe® Needle. It is easy to use, visualize and manipulate. It is ambidextrous and has a locking mechanism. It is very effective and has been used many times. Bleeding can be arrested in a short time. You do not have to abandon surgery and do not have to insert another trocar. Its use is straightforward and you do not have to struggle chasing a suture with a tiny hook.
   
   The other options:
2. Bipolar cauterization: it is cumbersome and takes a longtime.
   
3. Foley balloon transponade method: it may or may not do the job. You will have to insert another trocar to continue your laparoscopic surgery.
   
4. Extending incision for suture ligate: it defeats the purpose of laparoscopic surgery and laparoscopic procedure might have to be abandoned.
   

Fig. 1. Pass loaded needle through distal side of the injured blood vessel. Free ligature from the needle and withdraw empty needle

Fig. 2. Pass empty needle through the proximal side of the injured blood vessel. Thread end of ligature through the wire loop with the help of a grasper

Fig. 3. Tie ends of ligature over a folded 4x4 gauze. The gauze protects skin from cuts and augments tourniquet effect

Fig. 4. Repeat step 1 at the opposite side of the blood vessel injury

Fig. 5. Pass empty needle through the proximal side of the injured blood vessel. Thread end of ligature through the wire loop with the help of a grasper

Fig. 6. Tie ends of ligature to arrest bleeding

Remove sutures 8 hours post-op.