MAJOR RETROPERITONEAL VASCULAR INJURY DURING LAPAROSCOPIC SURGERY

We sought to assess the outcome of large retroperitoneal vascular inju ry that occurred during operative laparoscopy but was not related to t rocar or Veress needle injury. We conducted a retrospective review of cases operated and reviewed by our centres, Eight cases mere identifie d, Four women mere undergoing lymphadenectomy where vascular injury is a recognized risk. Distorted anatomy was a compounding factor in thre e of the remaining four patients who were undergoing intraperitoneal p rocedures, The injuries involved the inferior vena cava (n = 2), the r ight external iliac artery (n = 2), the left external iliac artery (n = 1), the right external iliac vein (n = 1), the hypogastric artery (n = 1) and the inferior mesenteric artery (n 1). Injuries were caused b y unipolar electrode (n = 1), electrosurgical scissors (n = 3), sharp scissors (n = 2) and CO2 laser (n = 2), The vessel injury was repaired at laparotomy in four women, The other four cases mere managed laparo scopically Transfusion attributable to the vascular injury occurred in two cases, The outcome in all cases was good, except for one in which the patient died, These cases demonstrate that all energy sources use d without proper understanding and caution can cause significant vascu lar injury, The adequacy and safety of laparoscopic control of major v essel bleeding should be investigated further and consultation with a vascular surgeon should be considered in all cases.