Major vascular injuries in laparoscopic surgery.
BACKGROUND
Major vascular injuries (MVI) still occur in laparoscopic surgery.


METHODS
We report our institution's experience of two MVI (aortic lesions) in a series of 3545 laparoscopies (July 1991-December 2000). We compared this experience with other series reporting MVI from Medline, Embase, Current Contents, and Best Evidence.


RESULTS
There were no deaths, but we had 23 postoperative and eight intraoperative bleedings, including two hepatic vessel lesions during dissection and six vascular lesions (four minor vessels and two aortic) related to trocar insertion. Prevention and treatment options are also discussed.


CONCLUSIONS
The incidence of MVI reported in the literature is 0.05%, but the true incidence is difficult to estimate because results are not always comparable and there is a possibility of underreporting. The mortality rates (8-17%) are high. No technique or instrumentation is completely safe; therefore, a high level of alertness must be maintained at all times and precautions must be adopted to avoid major complications.
Roviaro
G C
GC
Department of Surgery, S. Giuseppe Hospital Fbf, A.Fa.R, University of Milan, 12 Via San Vittore, 20123 Milan, Italy. gian.roviaro@unimi.it
Varoli
F
F
Saguatti
L
L
Vergani
C
C
Maciocco
M
M
Scarduelli
A
A
D001011:Aorta / Q000293:injuries; D016063:Blood Loss, Surgical; D001808:Blood Vessels / Q000293:injuries*; D006406:Hematoma / Q000209:etiology*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D012086:Reoperation; D013525:Surgical Instruments / Q000009:adverse effects