Vascular injury during laparoscopic gynaecological surgery: a methodological approach for prevention and management TOG 2020 Flashcards
How common is major vascular injury during laparoscopy?
1/200 (0.1-1.1)
What is the mortality risk following vascular injury?
8-23%
What are the most common causes of death following laparoscopy?
- Anaesthetic complications
- Vascular injury.
How common is conversion to laparotomy for major vascular injury?
1/380
What percentage of vascular injuries occur at time of veress/primary port?
75%
After how many unsuccessful attempts of verses need should Hassons/Palmers be used
After 2 unsuccessful attempts
64% vascular injury occur after 3 attempts
Mean vertical death of pneumoperitoneum at 10mmHg and 25mmHg
10mmHg 0.6cm with pressure
25mmHg 5.6cm with pressure
Risk peri-umbilical adhesions
- No surgery
- Previous Lap
- Previous transverse laparotomy
- Previous midline laparotomy
- No surgery 0.68%
- Previous Lap 1.6%
- Previous transverse laparotomy 20%
- Previous midline laparotomy 52%
At what level does the aorta bifurcate into right and left common iliac artery>
L4 - 5cm caphalad to 3cm caudal when supine
Which common iliac is more likely to be injured?
The right common iliac, as aortic bifurcation occurs just left of the midline
When can the corona mortis become injury?
Pelvic lymphadenectomy
Which is the most common vascular laceration
Inferior epigastric artery during placement of lateral troika
How to manage bleeding noted from port site during laparoscopy
- Electrosurgery to bleeding point
- Foley catheter inserted into port site a balloon inflated in cavity and pulled up against bleeding point
- Endo close suture
- IR embolisation
- Convert to open if rapidly expanding, haemodynamically unstable
