VENOUS DISSECTION INJURIES DURING LAPAROSCOPIC UROLOGICAL SURGERY

Purpose: The incidence of major venous dissection injuries during lapa roscopic procedures is assessed and recommendations are made for manag ement. Materials and Methods: We evaluated our experience with all maj or intra-abdominal injuries occurring during 274 consecutive laparosco pic-procedures performed within a 4-year period. Five patients (1.7%) had a total of 6 major vascular injuries, including gonadal vein avuls ion in 1 case, lumbar vein avulsion in 1 and a tear in the inferior ve na cava in 4. Two patients sustained inferior vena caval injuries duri ng nephrectomy because of adhesions from previous surgery and 1 of the m had 2 venacavotomies. Results: All vascular injuries were venous and 5 of the 6 major vessel injuries were treated successfully endoscopic ally via intracorporeal suturing techniques. The injury requiring open repair was a gonadal vessel avulsion that occurred during retroperito neal lymph node dissection early in our laparoscopic experience. Major vessel injuries were more likely to occur during complex laparoscopic procedures in patients who had undergone previous ipsilateral retrope ritoneal surgery. Conclusions: In select situations new techniques can allow for safe endoscopic control and repair of venous injuries durin g laparoscopic surgery.