Objectives: To show a number of injury management techniques for the bowel, urinary tract and vessels.

Materials and Methods: During laparoscopic surgery there is always the chance of intraoperative organ injuries. Prevention is the best strategy, but once injuries occur, finding and repairing them in the same operative session is vital to maintain the original minimally invasive target of the surgery.

The important issues are; very careful observation and understanding the high risk actions which most commonly lead to intraoperative injuries, and recognition of the organ injury. Unfound injuries can cause serious postoperative complications. Same operative session repair reduces difficulty and patient trauma.

Finding urinary tract injuries involves observing the suspect area and, possibly using IV dye to elucidate the leaking point. To find injuries along the small and large bowel, checking the course of the possible injury site is necessary. Injuries to the rectum can be checked by digital examination and air or dye leak tests. To find the bleeding point with vascular injuries it is important to temporarily control bleeding, to clarify the injured site.

Repair techniques shown include urinary tract, bowel and vasculature injury repair. For urinary tract and vascular injuries we use intracorporeal suturing in one layer, everted to prevent stenosis and thrombosis. For the bowel, we use a suturing or stapling technique. The suturing is double layered and the wound is inverted to prevent leakage and infection.

Results: All patients were able to undergo repair in the same operative session and all injuries were repaired laparoscopically.

Conclusion: Each type of injury and organ has characteristic requirements and appropriate techniques for intact repair. Following basic tenets of tension-free, angulation-free approximation and removing all unsound tissue will result in good repair with good blood perfusion.