Aortic injury during laparoscopic entry with a blunt trocar: A near-fatal complication rescued by multidisciplinary intervention

Abstract

Laparoscopic surgeries are now a tool in the arsenal of the majority of surgeons. Complications during entry access can lead to catastrophic outcomes, particularly when major vessel injuries occur. Although they provide significant learning opportunities, these major vascular injuries can be underreported. We present a rare case of an aortic injury during laparoscopic entry access with a blunt trocar in a 41-year-old male undergoing elective left nephrectomy. Despite initial safety precautions, the blunt trocar punctured the infrarenal abdominal aorta, resulting in significant retroperitoneal hemorrhage. The prompt recognition of the injury and multidisciplinary team response, including intravenous access and volume resuscitation by anesthesiology, urgent exploration by urology, and aorta repair by the vascular surgeon, prevented a fatal outcome. This case highlights that despite experience in laparoscopy, hurdles are encountered, and they must be reported to enhance the evidence base and learning opportunities.