236: Inadvertent Right Iliac Artery and Vein Injuries during First Trocar Placement: Immediate Laparotomy and Repair

Abstract

Study ObjectiveTo report inadvertent major vessel injuries during first trocar placement.DesignCase report.SettingSouthern Taiwan tertiary teaching hospital.PatientsA 38 year-old female, twice normal delivery, was admitted for laparoscopy-assisted vaginal total hysterectomy for the aggravated dysmenorrhea and menorrhagia due to adenomyosis.InterventionThe experienced surgeon (Dr Chuang), who had performed more than 500 laparoscopy procedure in the past 8 years, did the creation of pneumoperitoneum in a hurry and inserted first trocar. The sense of over-inserted first trocar was felt immediately.Measurements and Main ResultsEmergency laparotomy was performed and a total penetration hole of right iliac artery and vein was discovered. Artificial segmental vessel replacement was performed. Abdominal hysterectomy was done. The patient was discharged peacefully 7 days later.ConclusionInadvertent injuries to major vessels could be a catastrophe. Immediate recognition and emergent laparotomy is the only way to prevent mortality and litigation. Study ObjectiveTo report inadvertent major vessel injuries during first trocar placement. To report inadvertent major vessel injuries during first trocar placement. DesignCase report. Case report. SettingSouthern Taiwan tertiary teaching hospital. Southern Taiwan tertiary teaching hospital. PatientsA 38 year-old female, twice normal delivery, was admitted for laparoscopy-assisted vaginal total hysterectomy for the aggravated dysmenorrhea and menorrhagia due to adenomyosis. A 38 year-old female, twice normal delivery, was admitted for laparoscopy-assisted vaginal total hysterectomy for the aggravated dysmenorrhea and menorrhagia due to adenomyosis. InterventionThe experienced surgeon (Dr Chuang), who had performed more than 500 laparoscopy procedure in the past 8 years, did the creation of pneumoperitoneum in a hurry and inserted first trocar. The sense of over-inserted first trocar was felt immediately. The experienced surgeon (Dr Chuang), who had performed more than 500 laparoscopy procedure in the past 8 years, did the creation of pneumoperitoneum in a hurry and inserted first trocar. The sense of over-inserted first trocar was felt immediately. Measurements and Main ResultsEmergency laparotomy was performed and a total penetration hole of right iliac artery and vein was discovered. Artificial segmental vessel replacement was performed. Abdominal hysterectomy was done. The patient was discharged peacefully 7 days later. Emergency laparotomy was performed and a total penetration hole of right iliac artery and vein was discovered. Artificial segmental vessel replacement was performed. Abdominal hysterectomy was done. The patient was discharged peacefully 7 days later. ConclusionInadvertent injuries to major vessels could be a catastrophe. Immediate recognition and emergent laparotomy is the only way to prevent mortality and litigation. Inadvertent injuries to major vessels could be a catastrophe. Immediate recognition and emergent laparotomy is the only way to prevent mortality and litigation.