References: Trochar Injury; Volume 3 Issue 10

1. AUTHOR	Nordestgaard-A-G, Bodily-K-C, Osborne-R-W-Jr, Buttorff-J-D.
INSTITUTION	Cascade Vascular Associates, Tacoma, Washington 98405, USA.
TITLE	Major vascular injuries during laparoscopic procedures.
SOURCE	Am-J-Surg 1995 May, VOL: 169 (5), P: 543-5, ISSN: 0002-9610 18 Refs.
ABSTRACT	BACKGROUND: Major vascular complications following laparoscopic procedures are rare, with only 20 cases reported in the literature. PATIENTS AND METHODS: The cases of 4 patients who sustained 5 vascular injuries during laparoscopic procedures between June 1991 and May 1994 are presented, and previously reported cases in the literature are reviewed. RESULTS: All injuries occurred during pelvic laparoscopy (2 diagnostic procedures, 1 tubal ligation, and 1 hernia repair). The vascular injury was recognized during laparoscopy in 3 patients. In only 1 patient was immediate vascular surgery consultation requested. The iliac artery was injured in 3 patients, the iliac vein in 1, and the inferior epigastric artery in 1. The mechanism of injury was by the trocar in 2 patients and by sharp dissection in 2 patients. Arterial repair was accomplished by polytetrafluoroethylene (PTFE) interposition, PTFE patch angioplasty, resection and primary anastomosis, and ligation in 1 patient each. The venous injury was repaired by lateral venorrhaphy. Three patients recovered without sequelae, and 1 patient had a stroke. A review of the literature revealed only 20 reported cases of major vascular injuries as a result of the pneumoperitoneum needle or trocar insertion. Characteristically, the terminal aorta, cava, iliac arteries, and veins were injured. Most injuries were treated by direct suture repair. With immediate recognition, recovery was the rule; however, 3 of the 8 patients with delayed recognition died. CONCLUSION: Laparoscopists must be aware of this rare, serious, and potentially lethal complication. Once recognized, immediate conversion to an open procedure and application of appropriate vascular surgical techniques are required to reestablish arterial and venous continuity and minimize morbidity and mortality. Author.

2. AUTHOR	Saville-L-E, Woods-M-S.
INSTITUTION	Department of Surgery, University of Kansas School of Medicine- Wichita 67214, USA
TITLE	Laparoscopy and major retroperitoneal vascular injuries (MRVI).
SOURCE	Surg-Endosc 1995 Oct, VOL: 9 (10), P: 1096-100, ISSN: 0930-2794.
ABSTRACT	Injury to major retroperitoneal vessels is a potential serious complication of laparoscopy occurring when the Veress needle or trocar is inserted. This report is a review of major retroperitoneal vascular injuries (MRVI) occurring during laparoscopy, as these injuries have not been well documented in the literature. A retrospective, observational review of general surgical laparoscopy cases was conducted over a 3.5-year period in three community, university-affiliated hospitals. We identified 4 MRVI in 3591 laparoscopic procedures. These cases were critically analyzed and compared. The incidence of MRVI was approximately 0.1%. All cases occurred with the closed (blind) insertion technique of Veress needle and primary trocar insertion technique with disposable "safety" shield trocars. All patients sustaining MRVI had acute hypotension introperatively and significant blood loss necessitating postoperative transfusions. Recognition and rapid conversion to laparotomy are keys to enhancing outcome. There is significant potential for morbidity and mortality with laparoscopic MRVI, although each patient in this series was discharged without obvious short-term problems. The advantages of an open approach for primary trocar insertion are numerous and should alleviate the risk of MRVI associated with general laparoscopic surgery. Author.

3. AUTHOR	Bacourt-F, Mercier-F.
INSTITUTION	Hopital Americain de Paris, Neuilly.
TITLE	(Injuries to the abdominal aorta during laparoscopy). TT Plaies de l'aorte abdominale au cours des laparoscopies.
SOURCE	Chirurgie 1993-94, VOL: 119 (8), P: 457-61, ISSN: 0001-4001 15 Refs.
ABSTRACT	Member surgeons of the Societe de Chirurgie vasculaire de Langue franccaise participated in a survey concerning traumatic injury to the aorta and retrospectively reported nine cases of injury occurring during laparoscopic operations. Six had occurred in 1991 when video-laparoscopic surgery was becoming widespread. The laparoscopy had been indicated as a diagnostic procedure in 4 cases and for curative treatment in 5. Gynaecology disease were involved in 4 cases and digestive diseases in 5. Injury was reported near the aortic bifurcation or at the origin of the common right iliac artery. Concomitant injury to the small intestine (1 case) and to the mesentery (n = 3) were also reported. No venous injury was observed. Haemodynamic collapsus was the presenting sign and occurred early in 6 cases and late in 2. In 1 case, the haemorrhage occurred during the laparoscopic procedure itself and in another blood loss was visualized through the needle. An unsuccessful and unneeded procedure had been performed before the diagnosis in 4 cases: on splenectomy, two mesenteric dissections and one subcostal laparotomy after cholecystectomy. In all cases, the vascular surgeon had been called in by the operating surgeon and most often operated via the xypho-pubien route. After clamping the aorta, the vascular lesions was sutured. There was one death, directly related to late diagnosis. The frequency of injury to the abdominal aorta found in the literature and the difficulties in diagnosis was recalled. Mortality has been reported to vary between 13 and 23%. Such complications demonstrate the need for a rigorous technique but do not counterindicate the continued use of laparoscopic procedures. Author.

4. AUTHOR	Apelgren-K-N, Scheeres-D-E.
INSTITUTION	Department of Surgery, Michigan State University, College of Human Medicine, East Lansing 48824.
TITLE	Aortic injury. A catastrophic complication of laparoscopic cholecystectomy.
SOURCE	Surg-Endosc 1994 Jun, VOL: 8 (6), P: 689-91, ISSN: 0930-2794.
ABSTRACT	Two cases of aortic injury from trocar insertion during laparoscopic cholecystectomy are described and analyzed. The literature is reviewed and suggestions are offered for avoiding and treating this major complication. Both patients survived and are normal. Author.

5. AUTHOR	Carroll-L
TITLE	Precautions Necessary to Avoid Major Vessel Injuries During Laparoscopy
SOURCE	Medical Tribune: Obstetrician & Gynecologist Edition 04(08): 1997. 1997 Jobson Healthcare Group;