[Iatrogenic vascular lesions in laparoscopic interventions in gynecology]

Injuries to major vessels in the course of gynecological laparoscopic surgery are rare but serious, life-threatening complications. We report on five iatrogenic vascular injuries during minimally invasive surgery that occurred between January 1991 and May 1996 in obstetrical-gynecological services in the Austrian province of Styria. The total vascular complication rate is 0.05%. As this data shows, the distal abdominal aorta and vena cava as well as the large pelvic vessels are especially susceptible to injury when the Veress needle and trocars are inserted into the abdomen. Surgical reconstruction of these five arterial lesions required a PTFE patch in one case and the resection of the damaged section of the artery and reanastomosis in a second case. The remaining lesions, as well as an associated injury to the pelvic vein in one case was corrected with direct suturing of the vessel. Pelvic circulation was completely restored in all patients and permanent damage was avoided.