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Vascular injury during laparoscopic gynaecological surgery: a methodological approach for prevention and management
Author(s) -
Brierley Gemma,
Arshad Ilyas,
Shakir Fevzi,
Visvathanan Dilip,
Arambage Kirana
Publication year - 2020
Publication title -
the obstetrician and gynaecologist
Language(s) - English
Resource type - Journals
eISSN - 1744-4667
pISSN - 1467-2561
DOI - 10.1111/tog.12664
Subject(s) - medicine , laparotomy , resuscitation , vascular surgery , surgery , general surgery , cardiac surgery
Key content Major vascular injuries occur in up to one in 200 laparoscopies, most commonly during Veress needle insertion or primary trocar entry; laparoscopic surgeons should rehearse actions to be taken in case of injury. Vascular injury during laparoscopy is associated with significant morbidity and up to 23% mortality. Risk factors include previous surgery, intra‐abdominal pathology, low/high body mass index and complex surgeries. Techniques to manage vascular injury include aggressive fluid resuscitation, hyperbaric pressure, blood transfusion, manual pressure, considering conversion to an open midline laparotomy and the involvement of a vascular or general surgeon. Standardised assessment and management protocols should be rehearsed and available in all units.Learning objectives To be aware of the incidence of laparoscopic vascular injury and the potential complications that can occur. To recognise key risk factors for vascular injury and ways to prevent injury occurring. To rehearse drills on systematic emergency management of laparoscopic bleeding to standardise care; this is ideally suited to the realms of multidisciplinary simulation scenario‐based training, to improve a team’s response to a vascular injury.Ethical issues Are women who are at increased risk of vascular injuries appropriately counselled regarding complications and consequences, and are they given the options for alternative management?