Management of major vascular injury in laparoscopic urology

Objective

During the past three decades, laparoscopy has played a significant role in the management of urological disorders. This study aims to standardize the management of major vascular injury, which is a life-threatening complication in the laparoscopic urological procedures.

Methods

A total of 8210 patients with the urological disorder, who underwent laparoscopic surgery at Sir Run Run Shaw Hospital from January 2000 to December 2018, were included in this retrospective study. Patients’ data of the laparoscopic major vascular injury were collected and analyzed, and the basic principles of the procedure were summarized.

Results

A total of 15 (0.18%) cases of major vascular injury were found among the 8210 patients, and 2 of them were converted to open surgery. Although the type of laparoscopic surgery, causes, and management of major vascular injury among the patients were diverse, the main management strategies of major vascular injury in laparoscopic surgery were to keep the vision clear, control bleeding rapidly by clamping and compression, make full preparation for possibly needed liquid resuscitation, and try best to repair under laparoscope. If necessary, converse to open surgery.

Conclusion

Although the reported incidence of major vascular injury in laparoscopic urological surgery is extremely low, such injury can result in high morbidity and mortality. It is important to rapidly identify the cause and strictly follow the standardized management for better outcomes.