Aortic puncture with a laparoscopic fascial closure device.

Abstract

Vascular injury during laparoscopic surgery typically occurs with the blind insertion of either the Veress needle or the trocar. We report an aortic puncture from the use of a laparoscopic fascial closure device. After a laparoscopic-assisted vaginal hysterectomy and during closure of the 10-mm umbilical port with a fascial closure device, attempted passage of the needle encountered unusual resistance in the abdominal wall. Application of increased force resulted in uncontrolled entry of the needle into the abdominal cavity and a 1-mm puncture of the aorta. After emergency laparotomy the puncture was successfully repaired by a vascular surgeon. A previously unreported complication of this laparoscopic fascial closure device is aortic injury. Unusual resistance to passage of the needle should engender extra caution. The use of assistive closure devices should be reserved for patients with difficult anatomy.