External iliac artery injury as a complication during open laparoscopy through a left lower abdominal approach: case report and review of multi-institutional questionnaire survey.

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<B>Case Report: </B>A 42 year-old woman with previous laparotomy underwent laparoscopic surgery for a left ovarian dermoid cyst. There was a risk of colon injury in the primary approach because of abdominal wall adhesions. To avoid this risk, we chose open laparoscopy through the left lower abdominal approach. However, when the fascia was cut the external iliac artery was injured . We inspected the method and the anatomy around the area. We also conducted a multi-institutional questionnaire survey about the method of laparoscopy with previous laparotomy, which found that 6.7% of 104 Japanese hospitals active in laparoscopic surgery are performing open laparoscopy through the lower abdominal approach. The computed tomography of the patient suggested that open laparoscopy in the area distal to the iliac crest was close to the artery and is better done with mechanical skin traction.