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.