Cause and management of hemorrhage during laparoscopic colorectal cancer surgery        ZHAO Shi-dong, YE Ying-jiang, SHEN Zhan-long.Department of Gastroenterological Surgery, Laboratory of Surgical Oncology, Laboratory of General Surgery, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People′s Hospital, Beijing 100044, China
Corresponding author: SHEN Zhan-long, E-mail: shenzhanlong@pkuph.edu.cn
Abstract    Laparoscopic radical resection plays an important role in the treatment of colorectal cancer, while intraoperative bleeding is one of the difficult problems for colorectal surgeons. The causes of hemorrhage in laparoscopic surgery mainly include misidentification of anatomical planes, variation of vascular anatomy, improper operation under laparoscopy, anastomotic bleeding caused by digestive tract reconstruction, trocar puncture, and patient's personal factors. The prevention of intraoperative bleeding in laparoscopic colorectal cancer surgery is important. The vascular anatomy and the difficulty of exposure of anatomical planes should be evaluated when surgical plan is designed before operation. In addition, meticulous dissection should be performed during the operation, and the treatment to prevent bleeding should be done at every step. If bleeding occurs during the operation, the bleeding location should be exposed as soon as possible, and energy instruments, vascular clip ligation, suture and gauze compression should be applied for hemostasis. It should be converted to laparotomy in time when the hemostasis is poor or difficult under laparoscopy.