Venous dissection injuries during laparoscopic urological surgery.
OBJECTIVE
The incidence of major venous dissection injuries during laparoscopic procedures is assessed and recommendations are made for management.


METHODS
We evaluated our experience with all major intra-abdominal injuries occurring during 274 consecutive laparoscopic procedures performed within a 4-year period. Five patients (1.7%) had a total of 6 major vascular injuries, including gonadal vein avulsion in 1 case, lumbar vein avulsion in 1 and a tear in the inferior vena cava in 4. Two patients sustained inferior vena caval injuries during nephrectomy because of adhesions from previous surgery and 1 of them had 2 venacavotomies.


RESULTS
All vascular injuries were venous and 5 of the 6 major vessel injuries were treated successfully endoscopically via intracorporeal suturing techniques. The injury requiring open repair was a gonadal vessel avulsion that occurred during retroperitoneal lymph node dissection early in our laparoscopic experience. Major vessel injuries were more likely to occur during complex laparoscopic procedures in patients who had undergone previous ipsilateral retroperitoneal surgery.


CONCLUSIONS
In select situations new techniques can allow for safe endoscopic control and repair of venous injuries during laparoscopic surgery.
Thiel
R
R
Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Adams
J B
JB
Schulam
P G
PG
Moore
R G
RG
Kavoussi
L R
LR
D000328:Adult; D000368:Aged; D005260:Female; D006488:Hemostasis, Surgical; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000628:therapy; D010535:Laparoscopy / Q000009:adverse effects*; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D013536:Suture Techniques; D014680:Veins / Q000293:injuries*; D014682:Vena Cava, Inferior / Q000293:injuries*