Laparoscopic Major Vascular Injuries in Gynecologic Surgery for Benign Indications: A Systematic Review : Obstetrics & Gynecology

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Contents: Systematic Review

Laparoscopic Major Vascular Injuries in Gynecologic Surgery for Benign Indications

A Systematic Review

King, Nathan R. MD; Lin, Emily MD; Yeh, Chen MS; Wong, Jacqueline M. K. MD; Friedman, Jaclyn MD; Traylor, Jessica MD; Tsai, Susan MD; Chaudhari, Angela MD; Milad, Magdy P. MD, MS

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Obstetrics & Gynecology 137(3):p 434-442, March 2021. | DOI: 10.1097/AOG.0000000000004280


To identify the incidence, location, etiology, and mortality of major vascular injuries in gynecologic laparoscopy for benign indications.


A systematic review of PubMed, EMBASE, Cochrane Library,, and MEDLINE was conducted.


One thousand ninety-seven studies were screened for inclusion with 147 full-text articles reviewed. Sixty-six studies published between 1978 and 2016 met inclusion criteria, representing 197,062 surgeries. Articles that were included reported the incidence of major vascular injuries during gynecologic laparoscopy for benign indications. Exclusion criteria included surgery for gynecologic malignancy, duplicated data, case series and reports, manuscripts not in English, and studies published only as abstracts.


Injuries to the aorta, inferior vena cava, iliac (common, external, or internal), and inferior epigastric vessels were recorded, as were injuries denoted as major but not otherwise specified. A total of 179 major vascular injuries were reported with an incidence of 0.09% (95% CI 0.08–0.10). The inferior epigastric vessels were the most commonly injured vessel (0.04%, 95% CI 0.03–0.05), comprising 48% (95% CI 40–55) of all injuries. The majority of injuries occurred during abdominal entry (82%, 95% CI 76–89), and the remainder occurred during surgical dissection (18%, 95% CI 11–24). Most injuries were recognized intraoperatively (93%, 95% CI 87–100), and approximately half (55%, 95% CI 46–63) required laparotomy for repair. Only two of the 179 major vascular injuries resulted in death, for an overall mortality rate from vascular injuries of 0.001% (95% CI 0.000–0.004).


The incidence of major vascular injury during gynecologic laparoscopy found in this review is very low, and the vast majority of injuries did not result in death. Laparoscopy remains a safe surgical technique in relation to vascular injuries when performed for benign gynecologic disease.

© 2021 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.

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