Trocar and Veress needle injuries during laparoscopy

Abstract

Background: Inadvertent lesions of the intraabdominal organs and vessels caused by trocars and Veress needles are rare but serious complications of laparoscopic surgery. Establishing the pneumoperitoneum is believed to be the most dangerous step. Methods: The Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTS) prospectively collected the data on 14,243 patients undergoing various standard laparoscopic procedures between 1995 and 1997. This database was investigated with special regard to intraabdominal complications caused by trocars and Veress needles. Results: There were 22 trocar and four needle injuries (incidence, 0.18%). Nineteen lesions involved visceral organs; the remaining seven were vessel injuries. The small bowel was the single most affected organ (six cases), followed by the large bowel and the liver (three cases each). All vascular lesions, except for one laceration of the right iliac artery, occurred as venous bleeding of either the greater omentum or the mesentery. Fourteen trocars were inserted under direct vision. Nineteen trocar injuries were recognized intraoperatively; diagnoses of two small bowel and one bladder injuries were made postoperatively. Needle injuries were all diagnosed intraoperatively. Only five injuries could be repaired laparoscopically; the remaining lesions were repaired openly. Four patients underwent an open reoperation, and another patient needed five reoperations. There was one death (4.0%). Conclusions: Trocar and needle injuries are rare complications of laparoscopy. However, if not recognized intraoperatively and repaired immediately, they induce increased morbidity and mortality. Both open and closed establishment of the pneumoperitoneum are related to a potential danger of perforating lesions, but inserting the first trocar under direct vision allows early recognition and immediate repair.

Evaluation of tests performed to confirm the position of the Veress needle for creation of pneumoperitoneum in selected patients: a prospective clinical trial

“…Schafer et al 8 (2001) analyzed 26 major vascular injuries and reported that only four of them (15%) had been caused by inexperienced surgeons (surgeons who had performed fewer than 50 laparoscopic procedures). The other 22 injuries (85%) had been caused either by experienced surgeons (those who had performed between 51 and 100 procedures) or very experienced surgeons (over 100 procedures performed).…”

Current status of natural orifice trans-endoscopic surgery (NOTES) and laparoendoscopic single site surgery (LESS) in urologic surgery

“…This is most notable when the natural scar of the umbilicus is used for the port site. Furthermore, the risk related to the use of ports has been reported in 0.003-0.3% for both vascular and visceral injuries (9).…”

Bladder injuries in emergency/expedited laparoscopic surgery in the absence of previous surgery: a case series

“…1,2 However, in cases with no history of previous surgery, iatrogenic injury of abdominal viscera, particularly the bladder, from secondary laparoscopic ports is low. 3,4 While previous abdominal or pelvic surgery via a low transverse or low midline incision increases the risk of bladder injury, [5][6][7] this is not a prerequisite for this type of injury. Regardless of the presence or absence of previous surgery, various strategies can be employed to reduce the initial risk on port insertion such as catheterisation immediately prior to surgery.…”