Trocar injury to a major vessel will almost always result in brisk bleeding, regardless of whether the bleeding is arterial or venous. Signs of injury include rapidly increasing hemoperito­neum and changes to the patient’s pulse and blood pressure. Intravascular insufation is rare but can be fatal as massive venous gas embolism can lead to rapid cardiopulmonary collapse. Early signs may present as decreased end-tidal carbon dioxide (CO2), decreased oxygen satura­tion, or a “mill wheel” murmur audible with a stethoscope. Tachyarrhythmias and right-sided heart strain with ST-T wave changes may also be seen. Later ndings include increased central venous pressure and jugular venous distension. Fortunately, a lethal dose of intravascular CO2 is much higher than air (i.e., air embolism) as CO2 is rapidly absorbed and has higher solubility in blood.