Complete Evidence Regarding Major Vascular Injuries During Laparoscopic Access

Abstract

Recent reports by the Australian Safety and Efficacy Register for New interventions and Procedures (ASERNIP-S) and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) concluded that insufficient evidence is available to assess the safety of the open versus closed laparoscopy in regard to major vascular and visceral injuries. The aim of this study was to assess the relative safety of open and closed laparoscopy with respect to rates of major vascular and visceral injuries. A combined prospective/retrospective review of a single-surgeon series of 5900 open laparoscopies was performed. A meta-analysis of all reported series of open and closed laparoscopy was conducted using PubMed and MEDLINE search engines to compare major vascular and visceral injury rates. Medicolegal and manufacturer device reports were also reviewed. The case series of 5900 open laparoscopies reported a single visceral injury and no major vascular injuries. The meta-analysis revealed 336 major vascular injuries in 760,890 closed laparoscopies, a mean rate of 0.044%, 1 injury per 2272 cases, compared with 0 injuries in 22,465 open laparoscopies (P = 0.003). Visceral injuries occurred more frequently, 515 injuries in 760,890 closed laparoscopies (mean rate, 0.07) and 11 injuries in 22,465 open laparoscopies (mean rate, 0.05; P = 0.18). Medicolegal and device reports revealed a further 647 major vascular injuries and 500 major visceral injuries. In contrast to the conclusion formed by the RANZCOG and ASERNIP-S, the available evidence shows that open laparoscopy eliminates the risk of major vascular injury and reduces the rate of major visceral injuries. Open laparoscopy using the Hasson cannula should be the preferred method of peritoneal access.

Comparison of after Veres Closed Trocar and Open Entry Methods in Terms of Efficiency, Complications and Postoperative Pain in Gynecologic Laparoscopy: Prospective Study

“…Çalışmamızda vasküler yaralanma oluşmadı. Başka bir çalışmada her ne kadar durum istatistiksel olarak anlamlı değer-lere ulaşmasa da kapalı giriş tekniğinde vasküler yaralanma açık girişe göre daha fazla oranda tespit edilmiştir (13). Bu konuda literatürde karşıt çalışmalar da mevcuttur.…”

Designing safety into the minimally invasive surgical revolution

“…1). Based on a literature review, Larabina and Nottle estimated that a major vascular injury occurred, on average, every 2,272 procedures, and a visceral injury every 1,381 procedures [4]. van der Voort and colleagues reported that 42% of bowel injuries were from insertion of the trocar and 26% from electrosurgery with an overall mortality rate of 3.6% [5].…”

Laparoscopic entry: a review of Canadian general surgical practice

“…Despite the extremely low incidence of serious complications, 2 separate meta-analyses have demonstrated statistically higher rates of vascular and bowel injury with closed versus open laparoscopy. 29,30 The fact that more than 35% of general surgeons selectively use the Veress needle in their practices indicates some variance with regards to laparoscopic access capabilities and choice. Survey respondents also clearly described their preference for a periumbilical primary entry location.…”