The most common port problems are generally minor in nature. These include gas leak around the port (from too large hole) and minor bleeding at skin level. The latter is usually dealt with easily using cautery.

Hemorrhagic problems may start with port insertion or removal. If superficial bleeders are noted at the port site, they should be controlled with cautery or a suture. If a larger bleeder is noted after removing the port, it may be cauterized or sutured with the endoclose device.

Fortunately equipment failure is a rare problem. Although relatively unusual, one of the most common issues is that an energy device fails or alarms and needs to be replaced. Even more rare is that an instrument may be strained and snap or break within the patient during surgery. The instrument or its part can usually be retrieved laparoscopically.

Please review the accompanying video for this chapter.

When cautery is being used, it is critical to observe all unshielded areas of the operating field at all times to prevent inadvertent electrocautery arcing and injury. To minimize this risk, most instruments are almost completely shielded with covering insulation.

Nevertheless in some awkward situations, it is still possible to have arcing of diathermy current. Such situations include operating in the presence of distended bowel loops that may intrude on the area of dissection, arcing off another unshielded instrument such as a bowel clamp, and operating close to the retroperitoneum.