INTRODUCTION

Laparoscopy is an accepted method of treatment in gynecology, general surgery, urology, and pediatric surgery. It is generally safe, is usually well tolerated by patients, and, when compared to its open surgical counterpart, offers the advantages of less postoperative pain, reduced surgical trauma, and a shortened postoperative hospital stay. However, as with any surgical procedure, laparoscopy has technique-related complications. One of these complications is major vascular injury (MVI), of which consequences can be quite serious. Injuries to the large vessels (aorta, vena cava, iliac vessels, and mesenteric vessels) are commonly referred to as MVI and occur in a variety of laparoscopic fields (see Figure 20.1.1, Table 20.1.1). Many of these injuries occur while inserting the Veress needle and/or trocars through the abdominal wall and, as a result, do not occur in conventional procedures. While the reported incidence may be low, ranging from 0.05% to 0.14%, the mortality arising from these injuries is substantially higher and has been reported to reach up to 17% (see Table 20.1.2). Therefore, the rare occurrence of MVI carries with it the risk of a potentially catastrophic outcome.

INCIDENCE

MVI can occur in laparoscopic surgery during the early maneuvers required to enter the peritoneal cavity, or during the surgical dissection required for the specific procedure.