title: Injury of the thoracic aorta during laparoscopic esophagectomy.
abstract: We report an unusual complication of laparoscopic esophagectomy for carcinoma. During posterior transhiatal dissection, massive bleeding occurred from the left side of the supradiaphragmatic thoracic aorta. A small tear was clearly visible and temporary bleeding control by packing and pressure with a grasper through one of the trocars was effective. A median laparotomy was performed and the aorta was sutured using a standard laparoscopic needle holder. The esophagectomy was successfully completed through a right thoracic approach. Injury to the intrathoracic aorta may occur during transhiatal dissection of the lower mediastinum. Use of a laparoscopic needle holder allowed to repair the supradiaphragmatic aorta through a laparotomy without the need of patient repositioning for a transthoracic approach.
authors.affiliation: Department of Medical and Surgical Sciences, Division of General Surgery, IRCCS Policlinico San Donato, University of Milano, Italy. luigi.bonavina@unimi.it
authors.forename: Luigi
authors.initials: L
authors.lastname: Bonavina
authors.forename: Davide
authors.initials: D
authors.lastname: Bona
authors.forename: Greta
authors.initials: G
authors.lastname: Saino
authors.forename: Marco
authors.initials: M
authors.lastname: Nencioni
mesh_terms: D001013:Aorta, Thoracic / Q000293:injuries* / Q000601:surgery; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D006801:Humans; D007049:Iatrogenic Disease; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged