2022 Volume 38 Issue 1 Pages 63-68
Major vascular injury during laparoscopic surgery is an uncommon but serious complication.
An increase in the number and complexity of laparoscopic procedures has led to a corresponding increase in the risk of complications observed in clinical practice.
An 86-year-old woman with a history of obesity, hypertension, and knee replacement surgery underwent laparoscopic surgery for early-stage endometrial carcinoma. The external iliac vein was injured during dissection secondary to unipolar electrosurgery. We immediately grasped and held the lacerated blood vessel for 10 min using two atraumatic grasping forceps to decrease the pulse pressure. The injured vessel was laparoscopically repaired using a 4-0 polyglactin suture. The patient did not experience any leg pain the following day; however, the right dorsalis pedis artery pulse was feeble, and she had a cold sensation and edema of the right lower extremity with intermittent claudication. Therefore, we suspected arterial embolism. The patient underwent thrombectomy and stent placement for diagnosis of right iliac artery thrombosis, which successfully restored adequate blood flow to the right lower extremity. She did not show recurrence or complications in the right lower extremity during follow-up.
Arterial embolism in this patient was attributable to a crush injury of the artery as opposed to direct arterial trauma. Implementation of adequate protective measures is important to avoid intraoperative vascular injury. Moreover, early detection of symptoms is essential for prompt and appropriate treatment.
