Optical Trocar Causing Aortic Injury: A Potentially Fatal Complication of Minimal Access Surgery

Abstract

Trocar injury to abdominal aorta is uncommon and even rare with optical trocars. Such injury, resulting from umbilical trocar insertion, is potentially fatal. It often causes on-table death due to torrential life-threatening haemorrhage and unavailability of expert vascular help. We present a rare case of an injury to infra-renal abdominal aorta, caused by optical trocar insertion for bariatric surgery. Immediate recognition of the injury, deployment of life-saving manoeuvres, timely resuscitation, followed by definitive repair of aorta by vascular surgeon was life-saving for this patient. The recovery phase was uneventful and patient had no residual clinical problems during follow-up.

Initial entry via the left upper quadrant with an optical trocar in laparoscopic bariatric surgery

“…Obtaining initial access to the abdominal cavity is the crucial first step in laparoscopic BS 2,3 . Insertion of a Veress needle or optical viewing trocar has been reported as optimal for initial entry; 4–10 however, surgeons in Japan have little experience using a Veress needle or an optical viewing trocar.…”

“…Obtaining initial access to the abdominal cavity is the crucial first step in laparoscopic BS. 2,3 Insertion of a Veress needle or optical viewing trocar has been reported as optimal for initial entry; 4-10 however, surgeons in Japan have little experience using a Veress needle or an optical viewing trocar. About 90% of initial entries are by the open technique, 11 but open initial entry, although generally considered safe, may require an excessively large skin incision in morbidly obese patients.…”