Abstract
Vascular injuries, bowel injuries and organ injuries are often encountered in laparoscopic colectomy as accidental complications. Such injuries still sometimes occur even at present. We have performed 446 laparoscopic colectomy so far, among whom 14 cases of vascular injuries, 9 cases of bowel injuries and 1 case of organ injury have occurred. Though 12 cases of laparoscopic colectomy had to be converted to open surgery, conversion was not required in any of the vascular injury cases. In order to avoid these accidental situations, there are some significant steps that have to be followed in laparoscopic colectomy. Surgeons need to follow standard operative procedure, learn about the principle and characteristic of surgical devices, and acquire the skill of using those devices. Furthermore, the operator, his/her assistant and endoscopist should have sound anatomical knowledge concerning the membrane structure and proper dissection layer. The collaboration between clinicians can also lead to obtain a better surgical field of view. The surgeon, the assistant and endoscopist become the triunity. A coordinated operation should be carried out, and the visual field is ensured after the anatomical membrane structure and stratum disjunction are understood. However, we should not hesitate to convert to open laparotomy in those cases where the laparoscopic field of view is limited, or bleeding is poorly controlled.
