Riparazione di lesione della parete cavale in corso di nefrectomia radicale laparoscopica.

Laparoscopic radical nephrectomy is a standard procedure performed in many institutes. Major vascular complications, especially vena cava injury, are uncommon but serious. Early recognition and conversion to open procedure may be required. We report a case of vena cava injury during transperitoneal laparoscopic radical nephrectomy managed laparoscopically by a surgeon with an extensive experience with intracorporeal suturing, who operated at our institute as a tutor. Major vascular injuries during Iaparoscopic surgery are rare, with an incidence of 0.05%; they are due to malfunction of the instruments, errors made during dissection, misplacement of stapling devices during ligation and disorientation of the surgical field. In literature only two cases of vena cava transection during laparoscopic nepherectomy are reported. The result of these injuries is usually hemorrhage; traditional therapy is emergency laparotomy, consultation with a vascular surgeon and open repair, especially during retroperitoneal laparoscopy, where the available working space is limited and creates a special challenge for control of vascular accidents and performance of laparoscopic suturing maneuvers. The occurrence of major vascular accidents during laparoscopy and the rate of open conversion are related to operator. Vena cava injury during laparoscopic radical nephrectomy is a highly unlikely but potentially devastating complication, that in selected circumstances, can be managed laparoscopically only by surgeons with an extensive experience especially in intracorporeal suturing. [ABSTRACT FROM AUTHOR]