Laparoscopic Repair of External Iliac-artery Transection During Laparoscopic Radical Prostatectomy

Background And Purpose: Vascular injuries are the most common complication of pelvic lymph-node dissection. We report a case of total division of the external iliac artery and its immediate laparoscopic repair.

Methods: A 70-year-old man with a prostatic adenocarcinoma (Gleason Score 6) and serum prostate specific antigen concentration of 20 ng/mL had inadvertent external iliac-artery transection during pelvic lymphnode dissection secondary to the abnormal course and anatomy of the artery. Immediate laparoscopic repair was accomplished with a two-needle single-knot technique as is routinely used for the vesicourethral anastomosis. Thereafter, laparoscopic radical prostatectomy was completed.

Results: The reconstruction time was 37 minutes. There was no significant blood loss. There were no further intraoperative complications. Postrepair, the femoral pulse was intact, and follow-up duplex color ultrasonography showed good flow. The patient was disharged home on day 7, ambulant and asymptomatic.

Conclusion: In controlled cicumstances, laparoscopic repair of external iliac-artery transection is feasible and represents a safe alternative to open surgery.