Comment & Controversy

Scalpel size may also determine vascular injury rate

MAJOR VASCULAR INJURY DURING LAPAROSCOPY: PEARLS TO COPE
BY MAGDY MILAD, MD, MS (APRIL)

I suspect the culprit in some vascular injuries is the scalpel used to make the subumbilical skin incision. I have performed laparoscopy since 1973 and am fortunate to have had no vascular injuries. Since we started doing operative laparoscopy and using an assistant, I have noticed that many of my colleagues use a #11 blade for the skin incision, and while my preference is a #15 blade, I am often given a #11. As was noted in the article, in thin women the distance from the skin to the aorta (or right common iliac) where it crosses the vertebrae is not great, and it would be easy for the tip of a #11 blade to nick the vessel—especially while stretching the skin to make the incision.