Key result
Vascular laparoscopic injuries occur at a rate of 0.2/1000 but are associated with 6-13% morbidity and mortality, requiring prompt recognition and specific operative strategies.
A systematic skills and drills approach and practical algorithms are proposed to manage rare but potentially fatal major vascular injuries during laparoscopy.
Emphasizes vigilance for rare but serious vascular injuries during laparoscopy; leaves open questions on optimal training and prevention strategies.
Vascular laparoscopic injuries are rare (0.2/1000), however, they are associated with 6-13% morbidity and mortality. Commonest sites for catastrophic haemorrhage are the right iliac vessels, inferior vena cava and less commonly the abdominal aorta. The injuries commonly occur at entry using a Veress needle or insertion of trocars. These risks are inherent to all laparoscopic surgery. A systematic approach for managing these includes prompt recognition, communication within the operative team, immediate resuscitation and specific operative strategies for the control of vascular haemorrhage based on the location and severity of the injury. Major vascular injuries may require midline laparotomy and vascular surgeons. 1:1:1 resuscitation and adjunct haemostatic agents may help. Major vascular injury is a rare but a potentially fatal complication. We propose a skills and drills approach to improve outcomes. We also propose a practical algorithms for the management of haemorrhage in the acute situation.
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Asfour et al. (2018) conducted a review in Vascular laparoscopic injuries. Systematic approach for managing vascular laparoscopic injuries was evaluated. Vascular laparoscopic injuries occur at a rate of 0.2/1000 but are associated with 6-13% morbidity and mortality, requiring prompt recognition and specific operative strategies.
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