Intraoperative Management of Vascular Injuries During Laparoscopic Surgery

Abstract

Introduction: Widespread use of laparoscopy for major urological procedures has brought a whole new gamut of complications with it. Vascular complications are the second commonest complication encountered during laparoscopic surgery. In this video we elude to the tips and tricks in managing vascular complications. Materials and Methods: In this video we allude to how these complications occurred and how we managed them. The majority of the complications were managed by laparoscopic approach. During a laparoscopic donor nephrectomy, the gonadal vein got avulsed from its junction with the inferior vena cava (IVC) the bleeding was controlled by securing the bleeder with Maryland forceps and clips. An external iliac vein injury was managed by incorporeal suturing using hemlock clips, which were attached at the tail of the suture; this trick helped in approximation of the vein edges. We had an instance of injury to the renal artery; in this case due to the concern of patient safety, the bleeding was controlled by open approach. In one of the patients while exposing the retropubic space in a radical cystectomy, the inferior epigastric artery bled; the video shows how we managed this complication. Results: We describe management of the following patients, one each of renal vein, gonadal vein, and inferior epigastric artery injury, and two patients, each with aortic and external iliac vein injury. Conclusions: With experience, the majority of vascular injuries can be managed with laparoscopy. The salient features for managing these injuries are the following: organize yourself, have a good team, be prepared for open conversion, and single hand suturing skills help to tide over the situation. All authors have declared no conflicts of interest. Runtime of video: 7 mins 1 sec