Vascular injury during laparoscopic is a rare complication, but is the most common major complication in many urologic procedures.

Vascular injury may be due to errors of dissection or access-related trocar injury. These injuries can have devastating consequences resulting in significant morbidity and death. Vascular injuries are probably under-reported in the literature, and the true incidence is higher than realized.

Avoiding dissection injuries requires strict adherence to principles of dissection such as working from superficial to deep structures.

Successful management requires prompt control of the bleeding vessel and exposure, but early open conversion should be performed if control cannot be established or the surgeon has limited laparoscopic experience.

There is no one completely safe method of gaining laparoscopic access, and great care must be employed in whatever technique is used.

The successful management of laparoscopic access injuries rests on prevention, early recognition of injury, and immediate open conversion if injury is identified or suspected.

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