Uncommon Vascular Injury Caused by Scalpel Incision of Umbilicus for Primary Laparoscopy Entry

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Journal of Gynecologic Surgery


Background: Gynecologic laparoscopy has evolved over a period of time and now has become a well-established procedure. It is effective and has many advantages over conventional open surgery. Major vascular injury is the most serious and life-threatening complication and mostly occurs during insertion of a Veress needle or a trocar.

Case:A 48-year-old woman had a rare injury to her superior mesenteric artery (SMA) during a laparoscopic hysterectomy. The injury was caused by a scalpel blade during an umbilical incision made for the primary port. At that time, a retroperitoneal hematoma with a 1-cm puncture hole was seen over the area of the distal aorta, extending to the area of the right common iliac vessels, with slight bleeding from the puncture site. The hematoma was not expanding and the patient's vital signs remained stable. After removal of the uterus, inspection of the wound revealed a stable hematoma and slight bleeding from the puncture site. In the recovery room, the patient became vitally unstable. After fluid resuscitation and hemodynamic stabilization, computed tomography angiography was performed and showed active contrast medium extravasation at the branch of the right internal iliac artery and SMA branches. She was immediately shifted to an operating room for an exploratory laparotomy. The internal iliac arteries and SMA branches were explored and ligated.

Results: This patient's postlaparotomy course was unremarkable and she was discharged later in stable condition.

Conclusions: Although less likely to happen, an injury to the SMA via an umbilical incision can occur. Surgeons should practice extreme vigilance and be precise in any step of laparoscopic surgery. Extreme care should be practiced when making an umbilical incision especially in a thin patient. Prompt identification of the complication and treatment are important for successful management of a laparoscopic injury. Finally, adequate training and experience is required for performing difficult procedures, so that surgeons will learn necessary skills and gain the confidence to deal with complications.

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