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Pesce A, Fabbri N, Feo CV. Vascular injury during laparoscopic cholecystectomy: An often-overlooked complication. World J Gastrointest Surg 2023; 15:338-345. [PMID: 37032796 PMCID: PMC10080601 DOI: 10.4240/wjgs.v15.i3.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/05/2023] [Accepted: 02/23/2023] [Indexed: 03/27/2023] Open
Abstract
Laparoscopic cholecystectomy is one of the most frequently performed procedures in gastrointestinal surgery worldwide. Bleeding complications due to vascular injuries represent an important cause of morbidity and mortality, especially when facing major bleeding during laparoscopy, where bleeding control can be technically challenging in inexperienced hands. Interestingly, the reported incidence rate of conversion to open surgery due to vascular lesions is approximately 0%-1.9%, with a mortality rate of approximately 0.02%. The primary aim of this article was to perform an up-to-date overview regarding the incidence and surgical management of vascular injuries during laparoscopic cholecystectomy according to the available scientific evidence.
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Affiliation(s)
- Antonio Pesce
- Department of Surgery, University of Ferrara, Azienda USL of Ferrara, Azienda USL of Ferrara, Lagosanto 44023, Ferrara, Italy
| | - Nicolò Fabbri
- Department of Surgery, University of Ferrara, Azienda USL of Ferrara, Azienda USL of Ferrara, Lagosanto 44023, Ferrara, Italy
| | - Carlo Vittorio Feo
- Department of Surgery, University of Ferrara, Azienda USL of Ferrara, Azienda USL of Ferrara, Lagosanto 44023, Ferrara, Italy
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Miranda J, Dongarwar D, Salihu HM, Montero-Baker M, Gilani R, Pallister ZS, Mills JL, Chung J. Gender, Racial and Ethnic Disparities in Iatrogenic Vascular Injuries among the Ten Most Frequent Surgical Procedures in the United States. Ann Vasc Surg 2021; 80:18-28. [PMID: 34780954 DOI: 10.1016/j.avsg.2021.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/05/2021] [Accepted: 09/21/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Iatrogenic vascular injuries (IaVI's) appear to be increasing, with disparate prevalence across gender, race and ethnicity. We aim to assess the risk of IaVI's across these characteristics. METHODS Using the Nationwide Inpatient Sample for the years 2008 to 2015, we identified rates of IaVI's among the top ten most frequently performed inpatient procedures in the United States. Joint point regression was employed to examine the trends in the rates of IaVI's. We also calculated the adjusted odds ratios for IaVI's using survey logistic regression. RESULTS During the eight-year study period, a total of 29,877,180 procedures were performed (33.6% hip replacement, 14% knee arthroplasty, 11.2% cholecystectomy, 10.3% spinal fusion, 8.9% lysis of adhesions, 8% colorectal resection, 7.9% partial bone excision, 5% appendectomy, 0.6% percutaneous coronary angioplasty, 0.6% laminectomy). A total of 194,031 (0.65%) IaVI's were associated with these procedures. The incidence of IaVI's increased over time with an average annual percentage change (AAPC) of 4.2% (95% CI: 3.1, 5.4; P < 0.01). More females (105,747; 54.5%) than males (88,284; 45.5%) suffered IaVI's during their hospital admission (P < 0.01). Patients 70 years of age and older had the highest incidence of IaVI's (12,244,082; 34.3%; P ≤ 0.01). Among the ten index procedures, Non-Hispanic (NH) Whites underwent the highest proportion of procedures (14.1 procedures/100 hospitalizations; P < 0.01) and cholecystectomy was associated with the highest rate of IaVI's (19.4 per 1000 hospitalizations, P ≤ 0.01). Overall, patients from the lowest income quartile were least likely to suffer IaVI's (0.83 95% CI 0.79-0.88, P < 0.01) compared to the highest income quartile. All form of healthcare coverage increased the odds of IaVI's: Medicaid (1.07 95% CI 1.07-1.13, P < 0.01); Private insurance (1.35 95% CI 1.3-1.39, P < 0.01); Self-pay or no charge (1.45 95% CI 1.38-1.52, P < 0.01). IaVI's increased the odds of in-hospital mortality in all groups (1.25 95% CI 1.14-1.35, P < 0.01) and more pronounced in NH-Blacks (1.51 95% CI 1.15-1.99, P < 0.01). In the overall cohort, urban teaching hospitals observed the highest odds of in-hospital mortality (1.11 95% CI 1.07-1.15, P < 0.01). CONCLUSION Between 2008 to 2015, IaVI's rates for the top ten most frequently performed inpatient procedures increased by 33.6% (4.2% annually; P < 0.01). The elderly, females, and Hispanics more frequently had hospitalizations complicated by IaVI's. Overall, IaVI's independently increased the adjusted odds of mortality by 25%. IaVI's were most fatal among Blacks, about 50% elevated risk of death compared to NH-Whites. These benchmarks will be critical to future efforts to reduce IaVI, and associated healthcare disparities.
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Affiliation(s)
- Jorge Miranda
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston Texas
| | - Deepa Dongarwar
- Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston Texas
| | - Hamisu M Salihu
- Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, Houston Texas; Department of Family and Community Medicine, Baylor College of Medicine, Houston Texas
| | - Miguel Montero-Baker
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston Texas
| | - Ramyar Gilani
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston Texas
| | - Zachary S Pallister
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston Texas
| | - Joseph L Mills
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston Texas
| | - Jayer Chung
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston Texas.
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Kalmykov EL, Gaibov AD, Nematzoda O, Sharipov MA, Baratov AK. [Some aspects of iatrogenic vessel injury]. Khirurgiia (Mosk) 2021:85-91. [PMID: 33759475 DOI: 10.17116/hirurgia202104185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Iatrogenic events made up 1-10% of in-hospital mortality. Currently, iatrogenic vascular injuries are described for almost all surgical areas. Incidence of iatrogenic vascular injuries is gradually increased that is primarily associated with high number of percutaneous endovascular interventions. Surgical treatment of patients with iatrogenic vessel injuries is extremely difficult. This is due to sudden development of this complication, severe clinical state of the patient associated with underlying disease, acute massive blood loss, as well as insufficient experience of surgeon in urgent vascular surgery. Simple lateral or circular suturing is not always possible to restore the vessel integrity. Vascular replacement including non-standard vascular reconstructions are often required. Prevention of iatrogenic vascular injuries is also insufficiently described in the literature. Most manuscripts devoted to iatrogenic vascular injuries are usually represented by case reports or small sample. Thus, it is impossible to identify the main measures for prevention of iatrogenic injury.
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Affiliation(s)
| | - A D Gaibov
- Avicenna Tajik State Medical University, Dushanbe, Tajikistan
| | - O Nematzoda
- Republican Research Center for Cardiovascular Surgery, Dushanbe, Tajikistan
| | - M A Sharipov
- Avicenna Tajik State Medical University, Dushanbe, Tajikistan
| | - A K Baratov
- Republican Research Center for Cardiovascular Surgery, Dushanbe, Tajikistan
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Reparación quirúrgica vascular aorta-iliaca abdominal por lesión en procedimiento laparoscópico. CIRUGIA CARDIOVASCULAR 2019. [DOI: 10.1016/j.circv.2019.01.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Filis K, Sigala F, Stamatina T, Georgia D, Zografos G, Galyfos G. Iatrogenic Vascular Injuries of the Abdomen and Pelvis: The Experience at a Hellenic University Hospital. Vasc Endovascular Surg 2019; 53:541-546. [DOI: 10.1177/1538574419858809] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The aim of this study is to present the experience of a Vascular Division at a Hellenic University hospital concerning the management of iatrogenic vascular injuries (IVIs) of the abdomen or pelvis. Patients and Methods: This is a retrospective study evaluating all IVIs reported during a 10-year period in our institution. Only injuries warranting a vascular surgeon consultation were included in the study. Non-iatrogenic injuries were not included. Mortality and major complications within 30 days were evaluated. Results: Overall, 70 cases were recorded, with 41% being venous and 59% being arterial injuries. Iliac arteries (51%) were the most common location and rupture/lacerations (73%) were the most common type of injury. General surgery (61.5%) and cardiology (30%) procedures were the most frequently involved procedures. A 30-day mortality was 5.7%, with 30% of cases treated conservatively. Synthetic bypass grafting (odds ratio [OR] = 65.0; 95% confidence interval [CI], 4.022-1050.358; P = .003) and male gender (OR = 83.77; 95% CI, 4.040-1736.738; P = .004) were associated with death. Conclusions: Iatrogenic vascular injuries of the abdomen or pelvis are usually associated with general surgery and endovascular procedures. When vascular consultation is requested early, mortality could remain low. However, a selected number of stable patients with retroperitoneal or pelvic hematomas could be treated conservatively, yielding satisfying results.
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Affiliation(s)
- Konstantinos Filis
- First Propedeutic Department of Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Fragiska Sigala
- First Propedeutic Department of Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Triantafyllou Stamatina
- First Propedeutic Department of Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Doulami Georgia
- First Propedeutic Department of Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Zografos
- First Propedeutic Department of Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George Galyfos
- First Propedeutic Department of Surgery, Hippocration Hospital, National and Kapodistrian University of Athens, Athens, Greece
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6
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Cholecystectomy-related malpractice litigation: predictive factors of case outcome. Updates Surg 2019; 71:463-469. [DOI: 10.1007/s13304-019-00633-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/12/2019] [Indexed: 12/12/2022]
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7
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Chavarriaga A, Wyrzykowski A, Feliciano DV. Minimally invasive surgery? Trauma Surg Acute Care Open 2019; 3:e000290. [PMID: 30687787 PMCID: PMC6326355 DOI: 10.1136/tsaco-2018-000290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
| | - Amy Wyrzykowski
- Department of Surgery, WellStar Atlanta Medical Center, Atlanta, Georgia, USA
| | - David V Feliciano
- Shock Trauma Center/Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Cha J, Broch A, Mudge S, Kim K, Namgoong JM, Oh E, Kim P. Real-time, label-free, intraoperative visualization of peripheral nerves and micro-vasculatures using multimodal optical imaging techniques. BIOMEDICAL OPTICS EXPRESS 2018; 9. [PMID: 29541506 PMCID: PMC5846516 DOI: 10.1364/boe.9.001097] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Accurate, real-time identification and display of critical anatomic structures, such as the nerve and vasculature structures, are critical for reducing complications and improving surgical outcomes. Human vision is frequently limited in clearly distinguishing and contrasting these structures. We present a novel imaging system, which enables noninvasive visualization of critical anatomic structures during surgical dissection. Peripheral nerves are visualized by a snapshot polarimetry that calculates the anisotropic optical properties. Vascular structures, both venous and arterial, are identified and monitored in real-time using a near-infrared laser-speckle-contrast imaging. We evaluate the system by performing in vivo animal studies with qualitative comparison by contrast-agent-aided fluorescence imaging.
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Affiliation(s)
- Jaepyeong Cha
- Sheikh Zyaed Institute for Pediatric Surgical Innovation, Children's National Health System, 111 Michigan Avenue NW, Washington, DC 20010, USA
- These authors contributed equally to this work
| | - Aline Broch
- Sheikh Zyaed Institute for Pediatric Surgical Innovation, Children's National Health System, 111 Michigan Avenue NW, Washington, DC 20010, USA
- These authors contributed equally to this work
| | - Scott Mudge
- Sheikh Zyaed Institute for Pediatric Surgical Innovation, Children's National Health System, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Kihoon Kim
- Sheikh Zyaed Institute for Pediatric Surgical Innovation, Children's National Health System, 111 Michigan Avenue NW, Washington, DC 20010, USA
- Department of Surgery, Inje University Haeundae Paik Hospital, 875 Haeun-daero, Haeundae-gu, Busan 612-896, South Korea
| | - Jung-Man Namgoong
- Sheikh Zyaed Institute for Pediatric Surgical Innovation, Children's National Health System, 111 Michigan Avenue NW, Washington, DC 20010, USA
- Department of Surgery, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, South Korea
| | - Eugene Oh
- Sheikh Zyaed Institute for Pediatric Surgical Innovation, Children's National Health System, 111 Michigan Avenue NW, Washington, DC 20010, USA
- Department of Biomedical Engineering, The Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD 21218, USA
| | - Peter Kim
- Sheikh Zyaed Institute for Pediatric Surgical Innovation, Children's National Health System, 111 Michigan Avenue NW, Washington, DC 20010, USA
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Are Routine Blood Group and Save Samples Needed for Laparoscopic Day Case Surgery? World J Surg 2016; 40:1295-8. [DOI: 10.1007/s00268-016-3463-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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10
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Sotelo RJ, Haese A, Machuca V, Medina L, Nuñez L, Santinelli F, Hernandez A, Kural AR, Mottrie A, Giedelman C, Mirandolino M, Palmer K, Abaza R, Ghavamian R, Shalhav A, Moinzadeh A, Patel V, Stifelman M, Tuerk I, Canes D. Safer Surgery by Learning from Complications: A Focus on Robotic Prostate Surgery. Eur Urol 2015; 69:334-44. [PMID: 26385157 DOI: 10.1016/j.eururo.2015.08.060] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 08/31/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND The uptake of robotic surgery has led to changes in potential operative complications, as many surgeons learn minimally invasive surgery, and has allowed the documentation of such complications through the routine collection of intraoperative video. OBJECTIVE We documented intraoperative complications from robot-assisted radical prostatectomy (RARP) with the aim of reporting the mechanisms, etiology, and necessary steps to avoid them. Our goal was to facilitate learning from these complications to improve patient care. DESIGN, SETTING, AND PARTICIPANTS Contributors delivered videos of complications that occurred during laparoscopic and robotic prostatectomy between 2010 and 2015. SURGICAL PROCEDURE Surgical footage was available for a variety of complications during RARP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Based on these videos, a literature search was performed using relevant terms (prostatectomy, robotic, complications), and the intraoperative steps of the procedures and methods of preventing complications were outlined. RESULTS AND LIMITATIONS As a major surgical procedure, RARP has much potential for intra- and postoperative complications related to patient positioning, access, and the procedure itself. However, with a dedicated approach, increasing experience, a low index of suspicion, and strict adherence to safety measures, we suggest that the majority of such complications are preventable. CONCLUSIONS Considering the complexity of the procedure, RARP is safe and reproducible for the surgical management of prostate cancer. Insight from experienced surgeons may allow surgeons to avoid complications during the learning curve. PATIENT SUMMARY Robot-assisted radical prostatectomy has potential for intra- and postoperative complications, but with a dedicated approach, increasing experience, a low index of suspicion, and strict adherence to safety measures, most complications are preventable.
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Affiliation(s)
- René J Sotelo
- Center of Robotics and Minimally Invasive Surgery, Instituto Médico La Floresta, Caracas, Venezuela; University of Southern California, Los Angeles, CA, USA.
| | - Alexander Haese
- Martini Clinic Prostate Cancer Center, University Clinic Eppendorf, Hamburg, Germany
| | - Victor Machuca
- Center of Robotics and Minimally Invasive Surgery, Instituto Médico La Floresta, Caracas, Venezuela
| | - Luis Medina
- Center of Robotics and Minimally Invasive Surgery, Instituto Médico La Floresta, Caracas, Venezuela
| | - Luciano Nuñez
- Center of Robotics and Minimally Invasive Surgery, Instituto Médico La Floresta, Caracas, Venezuela
| | | | | | | | | | | | | | | | - Ronney Abaza
- Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Arieh Shalhav
- Duchossois Center for Advanced Medicine, Chicago, IL, USA
| | - Alireza Moinzadeh
- Lahey Hospital and Medical Center Institute of Urology, Burlington, MA, USA
| | - Vipul Patel
- Global Robotics Institute, Celebration, FL, USA
| | | | - Ingolf Tuerk
- St. Elizabeth's Medical Center, Brighton, MA, USA
| | - David Canes
- Lahey Hospital and Medical Center Institute of Urology, Burlington, MA, USA
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11
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Hindman NM, Kang S, Parikh MS. Common postoperative findings unique to laparoscopic surgery. Radiographics 2015; 34:119-38. [PMID: 24428286 DOI: 10.1148/rg.341125181] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The interpretation of images obtained in patients who have recently undergone abdominal or pelvic surgery is challenging, in part because procedures that were previously performed with open surgical techniques are increasingly being performed with minimally invasive (laparoscopic) techniques. Thus, it is important to be familiar with the normal approach used for laparoscopic surgeries. The authors describe the indications for various laparoscopic surgical procedures (eg, cholecystectomy, appendectomy, hernia repair) as well as normal postoperative findings. For example, port site hernias are more commonly encountered in patients with trocar sites greater than 10 mm and occur at classic entry sites (eg, the periumbilical region). Similarly, preperitoneal air can be encountered postoperatively, often secondary to trocar dislodgement during difficult entry or positioning. In addition, intraperitoneal placement of mesh during commonly performed ventral or incisional hernia repairs typically leads to postoperative seroma formation. Familiarity with normal findings after commonly performed laparoscopic surgical procedures in the abdomen and pelvis allows accurate diagnosis of common complications and avoidance of diagnostic pitfalls.
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Affiliation(s)
- Nicole M Hindman
- From the Departments of Radiology (N.M.H., S.K.) and Surgery (M.S.P.), NYU School of Medicine, 660 First Ave, New York, NY 10016
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12
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García-Alcázar D, García-Chapinal B, Batllori-Badia E, López-González G, Lorenzo-Hernando E, Jiménez-López JS, Muñoz-Hernando L, Muñoz-González JL. Psoas haematoma as a complication of Veress needle insertion: description of a case and literature review. BMC Surg 2014; 14:104. [PMID: 25488585 PMCID: PMC4268806 DOI: 10.1186/1471-2482-14-104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 12/05/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In terms of gynaecological laparoscopic surgery, major complications affecting great vessels, and especially the retroperitoneal ones, are unusual. CASE PRESENTATION We introduce a case of a retroperitoneal haematoma associated with psoas muscle pseudoaneurysm, as a side effect of Veress needle insertion, during laparoscopic surgery. Such complication was managed conservatively at first, requiring finally arterial embolisation. CONCLUSION Even though potential complications associated with laparoscopic surgery are infrequent, they must not be underestimated, and in some cases might need a multidisciplinary management.
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Affiliation(s)
| | | | | | | | | | - Jesús S Jiménez-López
- Gynecological Endoscopy Unit, Obstetrics and Gyneacology Service, University Hospital 12 de Octubre, Avda Cordoba s/n 28041, Madrid, Spain.
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Abstract
INTRODUCTION Laparoscopic tissue handling is quite difficult to measure using virtual-reality laparoscopic simulators and box-trainer exercises, and therefore, completion time is the predominant performance measure for simulation-based laparoscopic training exercises. The purpose of this study was to evaluate the construct validity of a training and assessment model for precise laparoscopic handling of delicate tissue. METHODS Participants (n = 35) completed 2 progressively challenging laparoscopic tissue translocation exercises using delicate foam pieces and templates. Deidentified performances were scored using objective measures for tissue damage, accuracy, percentage complete, and completion time. Evaluation included multiple analysis of variance with repeated measures among the 3 groups as follows: medical students, residents and faculty who perform laparoscopic surgery less than once per week, and faculty members who perform laparoscopic surgery at least once per week. RESULTS The model demonstrated significant construct validity by discriminating performances between the types of shapes and templates and across the levels of surgical experience on all dimensions. A significant interaction effect between the level of expertise and the difficulty of the exercise revealed excellent discrimination between experienced laparoscopic surgeons and others. DISCUSSION This low-cost model provides an alternative or adjunct platform for laparoscopic training and assessment that requires precise and measurable handling of a delicate tissue.
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14
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Van Koughnett JAM, Kalaskar SN, Wexner SD. Pitfalls of laparoscopic colorectal surgery and how to avoid them. COLORECTAL CANCER 2013. [DOI: 10.2217/crc.13.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
SUMMARY Laparoscopic surgery is commonly used for colorectal diseases. Recently, laparoscopy for colorectal carcinoma has increased in use, especially by colorectal surgeons. Laparoscopy is associated with potential pitfalls that pose challenges to the surgeon and team. The identification and management of these pitfalls may not directly parallel those during an open approach. As such, it is essential for the surgeon to have a good working knowledge of how to avoid potential problems and how to best manage them when they do occur. This review highlights common pitfalls of laparoscopic colorectal surgery, as well as offering practical approaches to their management. Technical, patient and surgeon factors are all discussed.
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Affiliation(s)
- Julie Ann M Van Koughnett
- Department of Colorectal Surgery, Cleveland Clinic FL, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA
| | - Sudhir N Kalaskar
- Department of Colorectal Surgery, Cleveland Clinic FL, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic FL, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA.
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15
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Techniques for laparoscopic repair of major intraoperative vascular injury: case reports and review of literature. Surg Endosc 2013; 27:3021-7. [DOI: 10.1007/s00464-013-2845-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 01/07/2013] [Indexed: 10/27/2022]
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16
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Kaafarani HM, D'Achille J, Graham RA. Non-trocar related major retroperitoneal bleeding during laparoscopic appendectomy. World J Emerg Surg 2011; 6:9. [PMID: 21426547 PMCID: PMC3070637 DOI: 10.1186/1749-7922-6-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 03/22/2011] [Indexed: 11/10/2022] Open
Abstract
Most of the reported vascular injuries in laparoscopic appendectomies occur during trocar or Veress needle insertions. As laparoscopy continues to evolve, it is essential that surgeons report unusual complications in an effort to raise awareness and guide management of any iatrogenic injury incurred during minimally-invasive procedures. We report the case of a patient who sustained a major non-trocar related retroperitoneal vascular injury during a routine LA.
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Effects of previous abdominal surgery incision type on complications and conversion rate in laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech 2011; 19:373-8. [PMID: 19851263 DOI: 10.1097/sle.0b013e3181b92935] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
For laparoscopic cholecystectomy, previous abdominal operations are seen as a relative contraindication. The purpose of this study was to investigate the effects of the incision type of previous abdominal surgery on laparoscopic cholecystectomy in terms of complications and conversion to open surgery. Data from 677 patients who had previously undergone abdominal surgery before undergoing laparoscopic cholecystectomy were prospectively collected and evaluated. From the previous operations, the incisions were upper abdominal in 66 patients, lower abdominal in 567, and upper plus lower in 44. Conversion rates in the upper, lower and upper plus lower groups were 27.27%, 2.82%, and 25%, respectively. Intraoperative major complications were bile duct injury (1 patient, upper plus lower incision group), small bowel mesentery injury, and aortic injury (1 patient each, both in the lower incision group). Postoperative major intra-abdominal complications were duodenal injury (1 patient, upper incision group) and small intestine injury (1 patient, lower incision group). The lower abdominal incision group had fewer adhesions in the upper abdomen than did the other 2 groups, and as a result had a much lower conversion rate.
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Sandadi S, Johannigman JA, Wong VL, Blebea J, Altose MD, Hurd WW. Recognition and management of major vessel injury during laparoscopy. J Minim Invasive Gynecol 2010; 17:692-702. [PMID: 20656569 DOI: 10.1016/j.jmig.2010.06.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 06/02/2010] [Accepted: 06/09/2010] [Indexed: 01/05/2023]
Abstract
Laparoscopy is one of the most commonly performed procedures in the United States. Injury to a major retroperitoneal vessel occurs in 0.3% to 1.0% of procedures, most commonly during laparoscopic entry while placing the Veress needle or primary trocar. Fatal outcome can be related to massive gas embolism or exsanguination. Recommended treatment for gas embolism can range from supportive measures to external chest compression and insertion of a central line to withdraw gas from the right side of the heart. Recommended treatment of major vessel injury with massive hemorrhage consists of rapid laparotomy and control of hemorrhage using direct pressure until a surgeon experienced in vascular procedures arrives. When a major vessel injury occurs in a surgical facility distant from a medical center and without an available surgeon with vascular experience, based on the trauma literature, we recommend temporary control of blood loss using abdominal packing and closure (i.e., "damage control surgery") and judicious resuscitation (i.e., "damage control resuscitation") before transportation to a medical center.
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Affiliation(s)
- Samith Sandadi
- Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Kuehnl A, Zimmermann A, Pongratz J, Eckstein HH. Young girl presenting with heart failure 5 years after laparoscopic appendectomy. Case report of an ilio-iliac AV fistula. Eur J Vasc Endovasc Surg 2010; 40:107-9. [PMID: 20347352 DOI: 10.1016/j.ejvs.2010.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2009] [Accepted: 02/21/2010] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Secondary arteriovenous (AV) fistulae following appendectomy are very rare. REPORT We report the case of a 15-year-old girl suffering from progressive heart failure and sub-acute abdominal pain caused by an ilio-iliac AV fistula 5 years after a complicated appendectomy. The vessel-wall defects were closed by open surgery and the aneurysmatic iliac vein was gathered. DISCUSSION Open fistula repair should be recommended to healthy and/or young patients, especially when they are not fully-grown. Endovascular treatment should be the therapy of choice in high-risk patients or patients with local contraindications against open surgery.
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Affiliation(s)
- A Kuehnl
- Clinic for Vascular Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
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Funk KH, Bauer JD, Doolen TL, Telasha D, Nicolalde RJ, Reeber M, Yodpijit N, Long M. Use of modeling to identify vulnerabilities to human error in laparoscopy. J Minim Invasive Gynecol 2010; 17:311-20. [PMID: 20227926 DOI: 10.1016/j.jmig.2010.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 01/12/2010] [Accepted: 01/14/2010] [Indexed: 10/19/2022]
Abstract
This article describes an exercise to investigate the utility of modeling and human factors analysis in understanding surgical processes and their vulnerabilities to medical error. A formal method to identify error vulnerabilities was developed and applied to a test case of Veress needle insertion during closed laparoscopy. A team of 2 surgeons, a medical assistant, and 3 engineers used hierarchical task analysis and Integrated DEFinition language 0 (IDEF0) modeling to create rich models of the processes used in initial port creation. Using terminology from a standardized human performance database, detailed task descriptions were written for 4 tasks executed in the process of inserting the Veress needle. Key terms from the descriptions were used to extract from the database generic errors that could occur. Task descriptions with potential errors were translated back into surgical terminology. Referring to the process models and task descriptions, the team used a modified failure modes and effects analysis (FMEA) to consider each potential error for its probability of occurrence, its consequences if it should occur and be undetected, and its probability of detection. The resulting likely and consequential errors were prioritized for intervention. A literature-based validation study confirmed the significance of the top error vulnerabilities identified using the method. Ongoing work includes design and evaluation of procedures to correct the identified vulnerabilities and improvements to the modeling and vulnerability identification methods.
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Affiliation(s)
- Kenneth H Funk
- School of Mechanical, Industrial, and Manufacturing Engineering, 204 Rogers Hall, Oregon State University, Corvallis, OR 97331-6001, USA.
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Kroh M, Rosenblatt S. Single-port, laparoscopic cholecystectomy and inguinal hernia repair: first clinical report of a new device. J Laparoendosc Adv Surg Tech A 2009; 19:215-7. [PMID: 19215215 DOI: 10.1089/lap.2008.0081] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To report the initial clinical cases of single-port, transumbilical cholecystectomy and inguinal hernia repair using a novel operating device. METHODS One patient each underwent single-port transumbilical cholecystectomy and transabdominal pre-peritoneal (TAPP) inguinal hernia repair using the Uni-X Single Port System (Pnavel Systems, Inc.). The device was placed through a single infraumbilical incision in both cases. Novel, specialized instruments, bowed in the shaft for triangulation, were used in addition to standard laparoscopic instrumentation. During cholecystectomy, a single stab incision was made and a laparoscopic suture passer was used for additional cephalad retraction of the gallbladder. RESULTS Both procedures were technically successful without placement of additional trocars. Operative times were 59 and 47 minutes for the cholecystectomy and inguinal hernia, respectively. Blood loss was minimal, and there were no intraoperative complications. The patient who underwent cholecystectomy had a previously placed infusion pump for chronic pain management and was kept overnight. The patient who underwent TAPP hernia repair was discharged the same day. Follow-up at three weeks postoperatively demonstrated the patients to be without complaints. CONCLUSIONS Transumbilical, single-port cholecystectomy and TAPP inguinal hernia repair are technically feasible. The first initial clinical experience with these procedures using this device is reported.
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Affiliation(s)
- Matthew Kroh
- Department of General Surgery, Surgical Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Sánchez Pérez B, Aranda Narvaez JM, Fernández Aguilar JL, Suárez Muñoz MA, Santoyo Santoyo J. [Treatment of retroperitoneal vascular lesions caused by a Cattell-Braasch manoeuvre during laparoscopy]. Cir Esp 2009; 87:186-7. [PMID: 19497564 DOI: 10.1016/j.ciresp.2009.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Accepted: 01/27/2009] [Indexed: 10/20/2022]
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Injuries caused by Veress needle insertion for creation of pneumoperitoneum: a systematic literature review. Surg Endosc 2009; 23:1428-32. [PMID: 19263124 DOI: 10.1007/s00464-009-0383-9] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2008] [Accepted: 01/17/2009] [Indexed: 10/21/2022]
Abstract
BACKGROUND The aim of this study was to assess the prevalence, risks, and outcomes of injuries caused by the Veress needle described in the literature. METHODS Iatrogenic injuries caused by Veress needle insertion during diagnostic or therapeutic laparoscopies in humans were researched, with no language restriction, in the Medline, Lilacs, Embase, Scielo, and Cochrane Library databases. The following words were combined: "Veress" or "insufflation needle" or "pneumoperitoneum needle," and "complications" or "injuries" or "lesions." The bibliographic references of the selected articles were also analyzed. We considered the following: (1) number of injuries described in the literature, (2) relationship between number of injuries and number of patients who underwent Veress needle insertion in the studies that reported Veress needle injury, (3) organs and structures injured (retroperitoneal vessels, digestive tract, and self-limited, minor injuries), and (4) outcome (death, conversion to laparotomy, laparoscopic repair, spontaneous resolution). RESULTS Thirty-eight selected articles included 696,502 laparoscopies, with 1,575 injuries (0.23%), 126 (8%) of which involved blood vessels or hollow viscera (0.018% of all laparoscopies). Of the 98 vascular injuries, 8 (8.1%) were injuries to major retroperitoneal vessels. There were 34 other reported retroperitoneal injuries, but the authors were not specific as to which vessel was injured. Of the 28 injuries to hollow viscera, 17 were considered major injuries, i.e., 60.7% (0.0024% of the total cases assessed). CONCLUSION The insertion of the Veress needle in the abdominal midline, at the umbilicus, poses serious risk to the life of patients. Therefore, further studies should be conducted to investigate alternative sites for Veress needle insertion.
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Piccinni G, Merlicco D, Centonze A, Sciusco A, Petrozza D, Testini M, Nacchiero M. The semiopen first umbilical trocar access technique in laparoscopic surgery: easy and safe. J Laparoendosc Adv Surg Tech A 2008; 18:865-8. [PMID: 18922062 DOI: 10.1089/lap.2008.0083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND First access in laparoscopy still causes trouble and a small percentage of visceral and vascular injuries. Residents and surgeons-in-training often have doubts about which technique is safer and "friendlier." Semiopen technique (SO) for the first umbilical trocar access was originally described in 2002. We report our retrospective analysis using SO that shows its safety and easiness. METHODS In the period from January 2003 to November 2007, 300 unselected patients, including obese patients (body mass index > 30) were treated with laparoscopy beginning with a periumbilical approach using SO. We usually prefer to enter the cavity with a STEP cannula stiffened by an unarmed Veress needle of 1.9 mm. There were 112 men and 188 women with ages ranging from 16 to 82 years. The procedure was performed by an expert laparoscopic surgeon in 260 cases and by residents or surgeons without expertise in laparoscopy in 40 cases. RESULTS We experienced no injuries of the viscera or vessels (0%). The mean time to enter the abdomen was 180 seconds, including obese patients. CONCLUSIONS After our limited experience with the SO, we believe that every surgeon who tries it will experience safety of the Hasson and the comfort of the Veress.
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Affiliation(s)
- Giuseppe Piccinni
- Department of Application in Surgery of Innovative Technologies, DACTI, Section of General Surgery, Università di Bari, Bari, Italy.
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Danan D, Winfree CJ, McKhann GM. INTRA-ABDOMINAL VASCULAR INJURY DURING TROCAR-ASSISTED VENTRICULOPERITONEAL SHUNTING. Neurosurgery 2008; 63:E613; discussion E613. [DOI: 10.1227/01.neu.0000325261.29689.fc] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
ABSTRACT
OBJECTIVE
Laparoscopic trocar injury is a relatively well-described complication of cholecystectomies and gynecological procedures. However, this type of injury has not been reported in association with adult neurological surgery. To increase awareness of this very serious risk, we report a case of intra-abdominal vascular injury during a shunt procedure involved with a common neurosurgical procedure.
CLINICAL PRESENTATION
A 76-year-old man with no previous abdominal surgical history presented with probable normal pressure hydrocephalus.
INTERVENTION
After an appropriate preoperative workup confirming probable normal pressure hydrocephalus, the patient consented to placement of a ventriculoperitoneal shunt with a programmable valve. During placement of the distal catheter using an abdominal trocar, the aorta was punctured inadvertently, necessitating emergency laparotomy for vascular repair.
CONCLUSION
An abdominal trocar should be used with caution in ventriculoperitoneal shunt surgery. Even with meticulous technique, vascular injury can occur with any trocar-based abdominal procedure. The neurosurgeon who uses this technique must be prepared to initiate emergent vascular access and repair, with a vascular surgery team available should such an injury occur. Alternatively, open placement of peritoneal catheters avoids blind peritoneal instrumentation and is an effective method for minimizing potentially catastrophic vascular injuries.
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Affiliation(s)
- Deepa Danan
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York
| | - Christopher J. Winfree
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York
| | - Guy M. McKhann
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York
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Akbari H, Kosugi Y, Kihara K. A novel method for artery detection in laparoscopic surgery. Surg Endosc 2007; 22:1672-7. [DOI: 10.1007/s00464-007-9688-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Accepted: 10/16/2007] [Indexed: 11/24/2022]
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Abstract
BACKGROUND Vascular injury during laparoscopic surgery typically occurs with the blind insertion of either the Veress needle or the trocar. We report an aortic puncture from the use of a laparoscopic fascial closure device. CASE After a laparoscopic-assisted vaginal hysterectomy and during closure of the 10-mm umbilical port with a fascial closure device, attempted passage of the needle encountered unusual resistance in the abdominal wall. Application of increased force resulted in uncontrolled entry of the needle into the abdominal cavity and a 1-mm puncture of the aorta. After emergency laparotomy the puncture was successfully repaired by a vascular surgeon. CONCLUSION A previously unreported complication of this laparoscopic fascial closure device is aortic injury. Unusual resistance to passage of the needle should engender extra caution. The use of assistive closure devices should be reserved for patients with difficult anatomy.
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Affiliation(s)
- Gene Lee
- Department of Obstetrics and Gynecology, Harbor-University of California Los Angeles, Torrance, California, USA.
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Karigiannis M, Pavlidis G, Papageorgiou G, Feretis C, Stamou KM, Vlachopoulos P. Delayed Presentation of Ilio-Iliac Arteriovenous Fistula Following Laparoscopic Cholecystectomy Treated with Percutaneous Graft-Covered Stent Placement. J Laparoendosc Adv Surg Tech A 2005; 15:411-4. [PMID: 16108748 DOI: 10.1089/lap.2005.15.411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Major vascular injuries during laparoscopic cholecystectomy are rare, usually readily apparent, and immediately treated. We report a case of delayed presentation of a retroperitoneal vascular injury. The patient presented with abdominal pain and increasing edema of the lower extremities 1 year after laparoscopic cholecystectomy and was found to have an ilio-iliac arteriovenous fistula. Endovascular treatment was accomplished using a graft-covered polytetrafluoroethylene stent. The patient remained free of symptoms at 1-year follow-up.
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Affiliation(s)
- Michael Karigiannis
- Department of Interventional Neuroradiology, Athens Medical Center Hospital, Athens, Greece
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