ABSTRACT
As hemorrhage is an inherent risk of all forms of surgery, the need to achieve rapid and reliable hemostasis is paramount for patient safety. This is particularly the case in laparoscopic surgery, as minimal access restricts the rapid use of hemostatic mechanisms by compression, clamping, and suturing. During surgery, hemorrhage can result from either failure to control significant arterial and venous sources or failure of normal clotting mechanism. The natural physiologic mechanism of hemostasis generally involves three crucial steps: vasoconstriction, platelet plug formation, and blood coagulation. When normal physiology fails to provide adequate hemostasis during surgery, additional measures are required to achieve effective and rapid hemostasis. The currently available techniques and agents to help achieve hemostasis can be broadly categorized into mechanical instruments, topical hemostatic agents, and systemic hemostatic agents. Hemorrhage is an intrinsic risk of all forms of surgery. The minimal access nature of laparoscopic surgery presents unique challenges in which meticulous surgical techniques are required to control hemorrhage. Besides physical techniques, both topical and systemic hemostatic agents are useful adjunctive agents. Knowledge of the available agents, their mechanism of action, and risks and benefits is crucial for optimal and appropriate utilization when required.
