Major vascular injuries during gynecologic laparoscopy

• Published in: Journal of the American College of Surgeons Vol. 185; no. 5; pp. 461 - 465
• Main Authors: Chapron, Charles M, Pierre, Fabrice, Lacroix, Sylvie, Querleu, Denis, Lansac, Jacques, Dubuisson, Jean-Bernard
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-11-1997; Elsevier Science; American College of Surgeons
• Subjects: Adult; Biological and medical sciences; Blood Vessels - injuries; Female; Genital Diseases, Female - surgery; Humans; Intraoperative Complications; Laparoscopy - adverse effects; Medical sciences; Middle Aged; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the genital tract and mammary gland; Human; Pathogenesis; Cardiovascular disease; Laparoscopy; Trauma; Statistical study; Abdomen; Female genital diseases; Incidence; Vascular disease; Treatment; Surgery; Blood vessel; Complication; Female; Surgical approach; Endoscopy; Lesion
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/S1072-7515(01)00958-9

Background:
This study was undertaken to report our experience with major vascular injuries in gynecologic laparoscopy in order to specify the circumstances under which they occurred, the means of diagnosis, the risk factors, and the means for prevention.
Study Design:
Retrospective case review study.
Results:
Seventeen patients with 21 major vascular 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 occurred during the laparoscopic surgery procedure. Eleven (84.6%) of the complications occurring during the set-up phase were secondary to insertion of the umbilical trocar and 2 (15.4%) to insertion of the needle used to create the pneumoperitoneum (P-needle). Half (6 cases; 54.5%) of the major vascular injuries secondary to insertion of the umbilical 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 these 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.