Lesões vasculares são complicações raras mas potencialmente fatais em cirurgia laparoscópica. O reconhecimento e manejo precoce são cruciais para evitar sérias consequências. É importante que cirurgiões recebam treinamento em cirurgia vascular e operem em hospitais com equipe de apoio vascular de plantão para lidar com qualquer emergência.
Roviaro Surgical Endoscopy(2002) 16:1192-1196 36 MVI de 77.000 colecistectomias , ¾ of MVI occurs during trocar insertions Peterson J Reprod Med 1990 35:587-589 0.26% en ginecologia G Vallancien J Urol ,168, 23-26 July 2002 Tres de estas 4 lesiones epigastricas requirieron reoperacion Chandler J Am Cloo Surg 192:478,2001 Wittz Br j Surg 84:800,1997 The active hand inserting the trocar should always be prevented from accidentally slipping or protrudng too deeply into the abdomen by contralateral hand on the abdomen of the patient,
MVI may be recognized either by direct visualization of free blood in the abdomen cavity or more commonly by a retroperitoneal hematoma. Anterior and posterior vessel wall lesions may occur. Multiples MVI Protective Shield did not retrn into the protective position on time Digital or sponge pressure rather than by using nonvascular instruments M Barbosa, Sao Paolo Med J, 205;12381):38-41 10% de la lesiones MVI are arterial and venous Laparotomy set open. Adequate skin incision Verres inclined caudally at 45° Insufflation pressure temporarily increased to 17 mmHg Open technique to gain access has least risk Secondary trocars placed under direct vision – transillumination
Intraoperative 1.6 % = 3/185 Gill J Urol vol 154,479-483 August 1995 Tiberio J Urol 168,1361-1365 october 2002 Misplacing, misfired an Endo-GIA 2/213 Marc Mc Allister J Urol 172,183-185 july 2004 . Misidentified of vena cava, the surgeons have more than 100 retroperitoneal operations J Kellogg , Urology 63(1) 2004 notably, 20% occured as a result of equipment malfunction, such as misfiring of endovascular GIA stapler Sautter. J. Urol. 2001; 165:515 Aortic clipation during bleeding control with a gastrointestinal stapler
Control is a lot more difficult in laparoscopic procedures thus the preevntion of bledding through careful preparation is the top priority in the laparoscopixc surgery
Control is a lot more difficult in laparoscopic procedures thus the preevntion of bledding through careful preparation is the top priority in the laparoscopixc surgery
Tiberio J Urol 168,1361-1365 october 2002 Gill J Urol vol 154,479-483 August 1995 the laparoscope can then be torqued towards the body wall.
Ovroutski Stanislav Srg Laparosc Endosc Percutan Tech 2001 Oct ;11(5) :334-7 fistula en paciente de 19 años , 20% de las fsitulas aorto cavas son after penetrating injuries to the aorta and vena cava , this case is ilio iliac M Barbosa, Sao Paolo Med J, 205;12381):38-41