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[Injuries to the abdominal aorta during laparoscopy]
Insights
Laparoscopic surgery can cause traumatic aortic injury, often near the aortic bifurcation. Early diagnosis and intervention are crucial to reduce mortality, which ranges from 13-23%.
Area of Science:
- Vascular Surgery
- Minimally Invasive Surgery
- Surgical Complications
Context:
- Laparoscopic surgery has become widespread, increasing the potential for iatrogenic injuries.
- Traumatic injuries to the abdominal aorta during laparoscopic procedures are rare but serious.
- A survey of French vascular surgeons identified nine cases of aortic injury during laparoscopy.
Purpose:
- To report on cases of traumatic aortic injury during laparoscopic operations.
- To highlight the diagnostic challenges and management of these vascular injuries.
- To assess the impact of these injuries on patient outcomes and surgical practice.
Summary:
- Nine cases of aortic injury during laparoscopy were reported, primarily affecting the aorta near its bifurcation or the iliac artery origin.
- Hemorrhagic shock was the common presentation, with delayed diagnosis in several instances leading to further complications.
- Surgical repair involved aortic clamping and suturing, with one death attributed to late diagnosis; reported mortality for such injuries varies between 13-23%.
Impact:
- These findings underscore the need for meticulous surgical technique during laparoscopic procedures.
- Despite the risks, the study suggests that laparoscopic procedures can continue to be used.
- Highlights the importance of prompt recognition and management of vascular injuries in minimally invasive surgery.
Abstract:
Member surgeons of the Société de Chirurgie vasculaire de Langue française participated in a survey concerning traumatic injury to the aorta and retrospectively reported nine cases of injury occurring during laparoscopic operations. Six had occurred in 1991 when video-laparoscopic surgery was becoming widespread. The laparoscopy had been indicated as a diagnostic procedure in 4 cases and for curative treatment in 5. Gynaecology disease were involved in 4 cases and digestive diseases in 5. Injury was reported near the aortic bifurcation or at the origin of the common right iliac artery. Concomitant injury to the small intestine (1 case) and to the mesentery (n = 3) were also reported. No venous injury was observed. Haemodynamic collapsus was the presenting sign and occurred early in 6 cases and late in 2. In 1 case, the haemorrhage occurred during the laparoscopic procedure itself and in another blood loss was visualized through the needle. An unsuccessful and unneeded procedure had been performed before the diagnosis in 4 cases: on splenectomy, two mesenteric dissections and one subcostal laparotomy after cholecystectomy. In all cases, the vascular surgeon had been called in by the operating surgeon and most often operated via the xypho-pubien route. After clamping the aorta, the vascular lesions was sutured. There was one death, directly related to late diagnosis. The frequency of injury to the abdominal aorta found in the literature and the difficulties in diagnosis was recalled. Mortality has been reported to vary between 13 and 23%. Such complications demonstrate the need for a rigorous technique but do not counterindicate the continued use of laparoscopic procedures.