MAJOR VASCULAR INJURIES DURING LAPAROSCOPIC PROCEDURES

BACKGROUND: Major vascular complications following laparoscopic proced ures are rare, with only 20 cases reported in the literature. PATIENTS AND METHODS: The cases of 4 patients who sustained 5 vascular injurie s during laparoscopic procedures between June 1991 and May 1994 are pr esented, and previously reported cases in the literature are reviewed. RESULTS: All injuries occurred during pelvic laparoscopy (2 diagnosti c procedures, 1 tubal ligation, and 1 hernia repair). The vascular inj ury was recognized during laparoscopy in 3 patients. In only 1 patient was immediate vascular surgery consultation requested. The iliac arte ry was injured in 3 patients, the iliac vein in 1, and the inferior ep igastric artery in 1. The mechanism of injury was by the trocar in 2 p atients and by sharp dissection in 2 patients. Arterial repair was acc omplished by polytetrafluoroethylene (PTFE) interposition. PTFE patch angioplasty, resection and primary anastomosis, and ligation in 1 pati ent each. The venous injury was repaired by lateral venorrhaphy. Three patients recovered without sequelae, and 1 patient had a stroke. A re view of the literature revealed only 20 reported cases of major vascul ar injuries as a result of the pneumoperitoneum needle or trocar inser tion. Characteristically, the terminal aorta, cava, iliac arteries, an d veins were injured. Most injuries were treated by direct suture repa ir. With immediate recognition, recovery was the rule; however, 3 of t he 8 patients with delayed recognition died. CONCLUSION: Laparoscopist s must be aware of this rare, serious, and potentially lethal complica tion. Once recognized, immediate conversion to an open procedure and a pplication of appropriate vascular surgical techniques are required to reestablish arterial and venous continuity and minimize morbidity and mortality.