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.