Introduction

Of the major complications associated with urologic laparoscopic surgery, vascular injuries are the most common. They can also become the most devastating complications during laparoscopic procedures resulting in significant morbidity and death.

Of the major complications associated with urologic laparoscopic surgery, vascular injuries are the most common (1-3). They can also become the most devastating complications during laparoscopic procedures resulting in significant morbidity and death.

These injuries often attract legal attention, and in one report, 62% of legal cases involving vascular injuries were settled in favor of the plaintiff (4). Too often, however, fear of litigation eliminates the opportunity to assess the cause and learn from the experience of others, and therefore many vascular injuries go unreported making the true incidence higher than that reported in the literature (5,6).

Vascular injuries may occur due to errors in dissection or from access-related injures and have been reported in 1.6% to 4.7% of urologic laparoscopic procedures (Table 1). Several series have reported their experience with vascular injury during urologic laparoscopic procedures; however, some studies have failed to distinguish vascular injury due to dissection from that due to access injuries.

Gill et al. noted vascular injuries in 3 (1.6%) of 185 patients undergoing laparo-scopic nephrectomy with two of the three injuries due to error in dissection (7). Fahlenkamp et al. reviewed the German experience with laparoscopic complications and found 40 vascular injuries in 2407 patients, making vascular injuries the most frequent complication in that report (1). Thiel noted six major vascular injuries during 274 transperitoneal laparoscopic cases for an incidence of 1.7% (8). All were venous dissection injuries, and the authors noted that vessel injury was more likely to occur during complex laparoscopic procedures in patients who had undergone previous surgery in the region. This concept was supported by a report by Meraney et al. who reviewed the complications of retroperitoneal laparoscopic surgery and noted seven vascular injuries in 404 patients for an incidence of 1.7% (9). Five of seven vascular injuries occurred during dissection and the majority of vascular injuries in this series occurred in patients who had previous abdominal surgery. Rassweiler et al. reported 22 vascular injuries out of 482 laparoscopic nephrectomies for a rate of 4.6% (10). Vascular complications during laparoscopic donor nephrectomy were recognized in 2.3% of cases and included stapler misfire in two, laparoscopic clip dislodgement in two, and vessel laceration during dissection in four patients (11). In a review of the Mayo Clinic experience with laparoscopic nephrectomy, vascular injury was the most common intraoperative complication (2). Four patients sustained dissection injuries and all required open conversion for control. There was one epigastric artery injury that was managed conservatively, bringing the total number of vascular injuries to 5 (1.8%). Finally, Siqueria et al. compiled their experience with major complications in 213 laparoscopic nephrectomies and reported 10 (4.7%) vascular injuries (3). Seven of the injuries were due to dissection errors

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