Injuries of the large vessels caused by laparoscopy
Zweigel, D.; Thiele, H.; Schworm, H.D.
Zentralblatt für Gynakologie 109(10): 673-678
1987
ISSN/ISBN: 0044-4197 PMID: 2956806 Document Number: 364612
Although gynecological laparoscopy is a relatively safe procedure with a lethality of 0.09%, occasionally serious complications arise such as intestinal perforation, peritonism, and injury to the major retroperitoneal vessels. It is latter complication that is addressed here. It occurs most often due to the very short distance between the skin and aortal bifurcation which is sometimes encountered. This complication can be prevented by the following. In particular, the far ventral position of the anterior vertebral edge must be considered, in which the trunk vessels are often only little more than 1 centimeter from the parietal peritoneum. Tangential insertion of a trocar or Verres needle should be avoided to prevent slitting the vessels. Nor should conical trocars or triangular trocars be used since in the case of a vascular lesion they can cause greater damage. If bleeding is suspected the entire retroperitoneum should be examined for a lesion. In retroperitoneal vascular injury it is not primarily intraabdominal bleeding which occurs since a retroperitoneal hematoma spreads first. One particular indication of trouble during surgery is a drop in blood pressure. If bleeding is found after examining the abdominal cavity, a trunk vessel is usually involved and immediate laparotomy is necessary.