Major Vascular Injury During Gynecologic Surgery

Abstract

Vascular injury is a rare but potentially fatal complication of gynecologic surgery. Reported risk factors for vascular injury during abdominal surgery include obesity, adhesions, vascular aberrations, and surgery at low-volume surgical centers. Oncologic procedures pose inherent additional risk of injury related to operating in proximity to major vascular structures or tumor involving the pelvic sidewall. Here we review major vascular injuries that may occur during hysterectomy and other types of gynecologic surgeries, with a focus on risk factors, prevention, recognition, and intraoperative management. All pelvic vasculature is at risk. Efforts to prevent injury include gentle and directional opening of avascular planes, cautious dissection of tumor and adherent lymph nodes from vascular structures, prophylactic ligation when indicated, and careful placement of initial and subsequent laparoscopic trocars. Recognition and control of injury must be immediate. Venous injuries manifest as nonpulsatile but potentially torrential hemorrhage, whereas an arterial injury typically presents with pulsatile bleeding from an obvious source. Repair of a major vascular injury is accomplished with pressure with or without hemostatic agents, suturing, clipping, or cautery depending on the clinical situation. (J GYNECOL SURG 37:200)