Critical Insights: Managing Retroperitoneal Vessel Injuries in Laparoscopic Surgery – ARC Summit
We now address retroperitoneal vessel injuries, which are among the most traumatic and potentially life-threatening complications in laparoscopy. Early recognition is crucial to patient survival. In the event of an injury, performing an up-and-down laparotomy, securing the aorta below the renal arteries, and ensuring rapid IV fluid administration are essential. If a hematoma forms, do not open it as it helps to compress the bleeding; instead, call for vascular surgical support immediately.
For example, during a 1994 presentation at the AGL meeting in New York, I discussed a case where we encountered every possible surgical principle violation. We were using a unipolar needle on a young patient with pelvic pain and didn’t have scissors available. The resident, exhibiting tremors, accidentally punctured the iliac vein. In a moment of panic and lacking laparoscopic suturing skills at the time, we managed to stop the bleeding using a blind probe, watched the patient closely, and luckily, she stabilized with only a large hematoma forming. This experience underlined the importance of preparedness and proper instrument availability.
Another incident involved a trocar injury during tubal ligation, where after the procedure, I discovered a mass behind the uterus which initially appeared to be a pelvic kidney. Upon further inspection, I found blood in the peritoneal cavity. The anesthesia team reported an inability to measure blood pressure due to equipment failure. It was then that I realized I had punctured the aorta. After freezing in shock, I considered withdrawing the trocar and pretending nothing happened, but this would have been fatal for both the patient and my career. Instead, I called for vascular surgeons, and we managed to transport the patient to a hospital where she survived, and so did I.
These experiences highlight the severe implications of retroperitoneal vessel injuries and the absolute necessity for vigilance, quick thinking, and immediate action. No technique is foolproof; injuries can occur with any method, whether conventional or advanced like robotic surgery. For instance, there was an incident involving robotic scissors inadvertently striking the aorta, demonstrating that even with modern technology, the risk of severe complications remains.
These stories serve as potent reminders of the risks involved in laparoscopic surgery and the critical importance of meticulous technique, proper training, and immediate response to complications to ensure patient safety and positive outcomes.
