Denis Querleu

Major vascular injuries during gynecologic laparoscopy

BACKGROUND This study was undertaken to report our experience with major vascular injuries in gynecologic laparoscopy in order to specify the circumstances under which they occurred, the means of diagnosis, the risk factors, and the means for prevention. STUDY DESIGN Retrospective case review study. RESULTS Seventeen patients with 21 major vascular injuries were identified. The average age of the patients was 33.8 +/- 11.6 years, and the mean body index mass was 21.6 +/- 3.08 kg/m2. Three of four of the accidents occurred during the set-up phase of laparoscopy (13 cases; 76.5%), and in 4 cases (23.5%) the accident occurred during the laparoscopic surgery procedure. Eleven (84.6%) of the complications occurring during the set-up phase were secondary to insertion of the umbilical trocar and 2 (15.4%) to insertion of the needle used to create the pneumoperitoneum (P-needle). Half (6 cases; 54.5%) of the major vascular injuries secondary to insertion of the umbilical trocar were observed when reusable trocars were used. In every case, the diagnosis was made during the operation. Two patients died, and two others presented a serious complication (phlebitis; acute ischemia requiring reoperation). CONCLUSIONS Major vascular injuries are rare but serious complications of laparoscopic surgery. Prevention of these accidents relies on the surgeons experience and scrupulous respect of the safety rules. In the vast majority of cases, it is necessary to convert to laparotomy immediately, calling in a vascular surgeon.

Complications of Gynecologic Laparoscopic Surgery -- A French Multicenter Collaborative Study

To the Editor: Despite the growth of laparoscopic surgery, its complications must not be underestimated. We describe a retrospective (1987 to 1989) and prospective (1990 to 1991) study of the compl...

Complications vasculaires majeures de la cœlioscopie gynécologique

OBJECTIVE: To specify the circumstances of occurence, the means of diagnosis, the risk factors and the means of prevention for major vascular injuries (MVI) during gynecologic laparoscopic procedure. STUDY DESIGN: Retrospective case review study of 24 patients. RESULTS: Twenty-four patients with 31 MVI were identified. The average age of the patients was 32.8 +/- 10.6 years and the mean body index mass was 22.4 +/- 4.0 kg/m2. Three of four of the MVI occurred during the setting-up phase of laparoscopy (19 cases; 79.2%). In five cases (20.8%) MVI occurred during the laparoscopic surgical procedure. Fifteen of the MVI occurring during the set up phase were secondary to insertion of the umbilical trocar and four to insertion of the needle used to create the pneumoperitoneum. A minimum of six MVI secondary to insertion of the umbilical trocar were observed with disposable trocars. In every case diagnosis was performed during the laparoscopic procedure. Five patients (20.8%) died and three others (12.5%) presented serious complications (phlebitis (one case); ischemia (two cases) with a reoperation for one patient). CONCLUSION: MVI are rare but serious complications of gynecologic laparoscopy. Prevention relies on the surgeons experience and strict respect of the safety rules. In the vast majority of cases, it is necessary to convert to laparotomy immediately, calling in a vascular surgeon.

Complications of laparoscopy: a prospective multicentre observational study

Sir, We were grateful to Professor Barlow for highlighting our research on women’s health during the menopause (Vol 104, August 1997)’ in his recent commentary (Vol 104, August 1997)2 and support his request for multidisciplinary co-operation in this area. As he rightly says, the psychological symptoms experienced by women study members aged 47 years in the MRC National Survey of Health and Development appear in part to reflect underlying factors which were detectable a decade earlier and suggest there is continuity of health in adult life. Professor Barlow also suggests that our study found that the increased problems among women taking hormone replacement therapy could be accounted for by predisposing factors noticeable at 36 years of age. So far we have no evidence that this is so, as we report in the discussion: “One hypothesis is that the relationship between psychological symptoms and HRT use may not be related to the experience of menopause per se but occur because HRT users have been more susceptible to these symptoms, or more inclined to report symptoms, at each life stage. However this hypothesis was not supported in this study which found no evidence that eventual HRT users had been more anxious and depressed at 36 years (data not shown), although both factors were important and independent predictors of psychological symptoms at 47 years.” As we are still following these women up and taking a full HRT history we plan to examine in detail the pattern of HRT use in this cohort, its relationship to current symptomatology, and whether long term users differ from the rest of the cohort, either in terms of earlier psychological difficulties or in ways which may have an effect on their future disease risk. This cohort are already heavy users of HRT by the age of 50 years two-fifths of women have tried taking HRT and over one-fifth have taken it for two years or more.