Iliac vascular injuries during elective laparoscopic surgery

Although it is extremely uncommon, iliac vascular injury is a serious complication of laparoscopic surgery. We performed a retrospective review of five patients who sustained injury to the iliac vessels during elective laparoscopic surgery. We reviewed the mechanism and location of injury for each case and examined ways in which such complications can be prevented, There were four women and one man; their mean age was 32 years. Three patients were undergoing laparoscopy at our institution, and two patients were transferred from outlying facilities soon after the injuries occurred. There were a total of seven iliac vascular injuries among our five patients. Three cases involved injury caused by the insufflation needle; the other two were injured by trocar introduction. Postoperative sequelae included decreased lower-extremity pulses in two patients and lower-extremity edema in three patients. The incidence of iliac vascular injury can be significantly reduced by proper insertion technique, the use of an open (Hasson) approach rather than the percutaneous insufflation needle, and a thorough knowledge of the vascular anatomy in the pelvic region.