Editorial Comment: Urologic surgery laparoscopic access: vascular complications

Branco et al. (¹) describe two cases of injuries during laparoscopic renal surgery; both recognized immediately and repaired laparoscopically. Laparoscopic entry complications are an uncommon but potentially life-threatening complication of laparoscopic surgery. Most such injuries occur during initial trocar insertion and most commonly involve major vessels and/or bowel. Failing to recognize these immediately is a leading cause of death in patients (²). A review by the U.S. Food and Drug Administration (FDA) committee found that there was insufficient evidence to recommend any particular access technique over the others (veress needle, direct trocar and hasson) largely due to poor centralized reporting of these complications (³). Whilst laparoscopic renal surgery is safe even in patients with previous abdominal surgery (⁴), surgeons must be experienced with access techniques, select patient appropriately for laparoscopic procedures, be familiar with trocar designs, use safe trocar insertion techniques and be vigilant for injuries during access. Whilst some of these injures may be amenable to laparoscopic repair, one should have a low threshold for conversion to open and seeking appropriate help (general or vascular surgeon) when necessary to manage these promptly and safely.

Homayoun Zargar, MD
Department of Urology
Royal Melbourne Hospital
300 Grattan St, Parkville
VIC 3050, Australia
E-mail: [e-mail]

REFERENCES

• ¹
  Branco AW. R Urologic Surgery Laparoscopic Access: Vascular Complications. Int Braz J Urol. 2016; 42: Ahead of Print
• ²
  Chandler JG, Corson SL, Way LW. Three spectra of laparoscopic entry access injuries. J Am Coll Surg. 2001;192:478-90; discussion 490-1.
• ³
  Fuller J, Scott W, Ashar B, Corrado J. Laparoscopic trocar injuries: a report from a US FDA Center for Devices and Radiological Health (CDRH) Systematic Technology Assessment of Medical Products (STAMP) Committee. 2005;1–14. Available at. http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm197339.htm
  » http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm197339.htm
• ⁴
  Zargar H, Isac W, Autorino R, Khalifeh A, Nemer O, Akca O, et al. Robot-assisted laparoscopic partial nephrectomy in patients with previous abdominal surgery: single center experience. Int J Med Robot. 2015;11:389-94.

Publication Dates

• Publication in this collection
  Jan-Feb 2017