MAJOR VASCULAR INJURIES DURING GYNECOLOGIC LAPAROSCOPY

Background: This study was undertaken to report our experience with ma jor vascular injuries in gynecologic laparoscopy in order to specify t he circumstances under which they occurred, the means of diagnosis, th e risk factors, and the means for prevention, Study Design: Retrospect ive case review study, Results: Seventeen patients with 21 major vascu lar injuries were identified, The average age of the patients was 33.8 +/- 11.6 years, and the mean body index mass was 21.6 +/- 3.08 kg/m(2 ). Three of four of the accidents occurred during the set-up phase of laparoscopy (13 cases; 76.5%), and in 4 cases (23.5%) the accident occ urred during the laparoscopic surgery procedure, Eleven (84.6%) of the complications occurring during the set-up phase were secondary to ins ertion of the umbilical trocar and 2 (15.4%) to insertion of the needl e used to create the pneumoperitoneum (P-needle), Half (6 cases; 54.5% ) of the major vascular injuries secondary to insertion of the umbilic al trocar were observed when reusable trocars were used, In every case , the diagnosis was made during the operation, Two patients died, and two others presented a serious complication (phlebitis; acute ischemia requiring reoperation), Conclusions: Major vascular injuries are rare but serious complications of laparoscopic surgery, Prevention of thes e accidents relies on the surgeon's experience and scrupulous respect of the safety rules, In the vast majority of cases, it is necessary to convert to laparotomy immediately, calling in a vascular surgeon, U A m Coil Surg 1997;185:461-465, (C) 1997 by the American College of Surg eons).