Vascular and bowel complications during retroperitoneal laparoscopic surgery.

Objective: We report on vascular and bowel complications during major retroperitoneal laparoscopic renal and adrenal surgery.

Methods: A total of 404 patients underwent retroperitoneoscopy for various renal and adrenal pathology between July 1997 and February 2001. The occurrence of intraoperative vascular and bowel injuries, specific intraoperative circumstances, management techniques and outcomes were evaluated.

Results: There were 7 vascular injuries (1.7%) and 1 bowel injury (0.25%), which involved the right adrenal vein (2), left renal vein (2), right renal vein (1), right renal artery (1), inferior vena cava (1) and a superficial, small serosal injury to the duodenum (1). Of these 8 cases 5 (63%) had been treated prior with major open intra-abdominal surgery. Average blood loss for patients with vascular injuries was 1,186 cc (range 300 to 3,000). Of the 8 cases 1 was converted to open surgery and in another 2 cases the vascular injury was controlled through the extraction incision, which had already been created. Retroperitoneoscopic control and repair without open conversion were possible in each of the most recent 5 cases. Of the 404 cases open conversion has not been necessary for control of vascular or bowel complications in the most recent 200 cases, demonstrating the impact of the learning curve.

Conclusions: During major renal and adrenal retroperitoneoscopic surgery our incidence of vascular and bowel injuries was 1.7% and 0.25%, respectively. With experience inadvertent vascular and bowel injuries can be efficaciously controlled retroperitoneoscopically despite the somewhat small operative field available.