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Laparoscopic Major Vascular Injuries in Gynecologic Surgery for Benign Indications: A Systematic Review.
Nathan R King1, Emily Lin, Chen Yeh
1Department of Obstetrics and Gynecology and the Division of Biostatistics, Department of Preventive Medicine, Northwestern Feinberg School of Medicine, Chicago, Illinois; and the Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Major vascular injuries during gynecologic laparoscopy for benign conditions are rare, with a very low mortality rate. This systematic review confirms laparoscopy remains a safe surgical option for these procedures.
Area of Science:
- Gynecologic Surgery
- Minimally Invasive Procedures
- Vascular Trauma
Background:
- Gynecologic laparoscopy is a common surgical approach for benign conditions.
- Vascular injuries are a potential complication of laparoscopic procedures.
- Understanding the incidence and outcomes of these injuries is crucial for patient safety.
Purpose of the Study:
- To determine the incidence, location, causes, and mortality associated with major vascular injuries during gynecologic laparoscopy for benign indications.
- To assess the safety of laparoscopy concerning vascular trauma in this patient population.
Main Methods:
- A systematic review was conducted across multiple databases (PubMed, EMBASE, Cochrane Library, ClinicalTrials.gov, MEDLINE).
- Sixty-six studies published between 1978 and 2016, encompassing 197,062 surgeries, met the inclusion criteria.
- Data on major vascular injuries, including vessel type, timing of injury, recognition, and management, were extracted and analyzed.
Main Results:
- The overall incidence of major vascular injury was 0.09% (95% CI 0.08-0.10), with inferior epigastric vessels being the most frequently injured (0.04%).
- Most injuries occurred during abdominal entry (82%) and were recognized intraoperatively (93%).
- Only two deaths were reported, resulting in a mortality rate of 0.001% for these injuries.
Conclusions:
- Major vascular injuries during gynecologic laparoscopy for benign conditions are infrequent.
- The mortality associated with these injuries is very low.
- Laparoscopic surgery for benign gynecologic disease is a safe technique with respect to vascular trauma.
