Use of the Hasson cannula producing major vascular injury at laparoscopy

Despite the recent demonstration that vascular lesions occur significantly more frequently in patients having closed rather than "open" laparoscopy, t here never has been a published case report of injury to the great vessels associated with the open technique of initial access to the peritoneal cavi ty at laparoscopy. We present the first two such cases reported, along with a brief review of the literature related to such major vascular injuries ( MVI) sustained at laparoscopy. Lacking appreciation of aortic anatomy and i ntraoperative technical factors contribute to the occurrence of these injur ies. Delayed diagnosis and management contribute to poor outcomes. Secondar y injury frequently is associated with MVI at laparoscopy.