Techniques for laparoscopic repair of major intraoperative vascular injury: case reports and review of literature.

Overview

BACKGROUND: Laparoscopic surgery has become increasing popular, and its use has been proven safe. However, major vascular injuries during laparoscopic procedures can have devastating effects, and there is a paucity of information regarding their intraoperative management. Here we report our experience with laparoscopic vascular injury repair and analyze the available literature on this topic. METHODS: Two cases of iliac vessel injury during laparoscopic colectomy were reviewed from a single surgeon's experience with of over 1,000 major laparoscopic procedures. The details of injury, techniques used, and outcomes were analyzed. A review of the literature was also conducted via PubMed. RESULTS: An injury to the left common iliac artery in a 75-year-old man and an injury to the left external iliac vein in a 39-year-old man during laparoscopic sigmoid colectomy are described, with successful laparoscopic vascular repair in both. Estimated blood loss was 300 and 250 ml, respectively. Patients were discharged home on postoperative days 4 and 3 without complications. A review of the literature yielded descriptions of a total of 704 major vascular injuries, with 6 case reports of vascular injuries involving the iliac vessels and inferior vena cava with successful laparoscopic repair. CONCLUSIONS: Laparoscopic repair of major vasculature is feasible if sound techniques are followed. We describe a stepwise technique for dealing with intraoperative laparoscopic vascular injury.