Liver Injury During Urologic Laparoscopy

The liver is one of the largest solid organs in the body, making up approximately one-fiftieth of the total body weight. The intraperitoneal lower border of the liver extends well below the costal margin on the right side. It is made up of two lobes separated by a line drawn from the IVC to the gallbladder fossa, and has a dual blood supply from the hepatic artery and portal vein. Due to its large size and intraabdominal location it is at risk for injury during transperitoneal laparoscopic operations. The majority of injuries occur either during needle/trocar insertion or from retraction of the liver during right kidney or adrenal surgery. Fortunately, the majority of injuries to the liver encountered during urologic laparoscopy is minor and can be managed laparoscopically. However, urologists should have a low threshold for conversion to an open procedure if an extensive injury occurs.