Major vessel injury during advanced laparoscopic surgery

Eight cases of large vessel laceration occurred during operative laparoscopy, but were not related to cannula or Veress needle injury. Four injuries were managed at laparoscopy. One patient was operated on by us. We reviewed four cases for colleagues, and the remainder were subject to litigation. Four women were undergoing lymph node dissection and three others had endometriosis or adhesions that obliterated the normal anatomy. The injury involved the inferior vena cava in two women, the right external iliac artery in four, and the left hypogastric and inferior mesenteric artery in one woman each. Vascular lacerations were caused by unipolar electrosurgery in two patients and by the carbon dioxide laser in two. In the remaining four women the injury to the artery or vein occurred during sharp dissection. The vessel injury was repaired by the conventional open technique in four women. The other four were managed laparoscopically, two by applying metal clips on the vessel wall and one with bipolar electrocoagulation. The outcome in all patients was good except for one, who died.