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[Major vascular complications from gynecologic laparoscopy]
C Chapron1, F Pierre, D Querleu
1Service de chirurgie gynécologique, clinique universitaire, pavillon Baudelocque, service du Dr-Dubuisson, 123, boulevard Port-Royal, CHU Cochin Saint-Vincent de Paul, 75004 Paris, France. charles.chapron@cch.ap-hop-paris.fr
Objective:
To specify the circumstances of occurence, the means of diagnosis, the risk factors and the means of prevention for major vascular injuries (MVI) during gynecologic laparoscopic procedure.
Study Design:
Retrospective case review study of 24 patients.
Results:
Twenty-four patients with 31 MVI were identified. The average age of the patients was 32.8 +/- 10.6 years and the mean body index mass was 22.4 +/- 4.0 kg/m2. Three of four of the MVI occurred during the setting-up phase of laparoscopy (19 cases; 79.2%). In five cases (20.8%) MVI occurred during the laparoscopic surgical procedure. Fifteen of the MVI occurring during the set up phase were secondary to insertion of the umbilical trocar and four to insertion of the needle used to create the pneumoperitoneum. A minimum of six MVI secondary to insertion of the umbilical trocar were observed with disposable trocars. In every case diagnosis was performed during the laparoscopic procedure. Five patients (20.8%) died and three others (12.5%) presented serious complications (phlebitis (one case); ischemia (two cases) with a reoperation for one patient).
Conclusion:
MVI are rare but serious complications of gynecologic laparoscopy. Prevention relies on the surgeon's experience and strict respect of the safety rules. In the vast majority of cases, it is necessary to convert to laparotomy immediately, calling in a vascular surgeon.