Iatrogenic Left External Iliac Artery Dissection Following Robot-Assisted Surgery for Endometrial Cancer: A Case Report

Major vascular injury is a rare but potentially serious complication of minimally invasive gynecologic surgery.Most reported vascular injuries occur during abdominal entry or result from direct vessel injury; however, delayed arterial dissection and occlusion following pelvic lymphadenectomy are extremely uncommon.We report a case of external iliac artery dissection and occlusion after robot-assisted surgery for endometrial cancer.A woman in her 60s presented with abnormal uterine bleeding and was diagnosed with grade 2 endometrioid carcinoma.Preoperative imaging showed less than 50% myometrial invasion without evidence of lymph node or distant metastasis, corresponding to clinical stage IA disease.She underwent robot-assisted surgery with pelvic lymphadenectomy.The operative time was 349 minutes, and estimated blood loss was 83 mL.Final pathology revealed grade 2 endometrioid carcinoma with myometrial invasion, no lymphovascular space invasion, negative surgical margins, and no lymph node metastasis in 44 resected lymph nodes.Postoperatively, she received three cycles of paclitaxel and carboplatin.After surgery, she developed persistent paresthesia in the left inguinal region and difficulty climbing stairs.These symptoms were initially considered consistent with transient genitofemoral or obturator nerve dysfunction associated with pelvic lymphadenectomy, and she was therefore observed conservatively.However, the symptoms persisted after completion of chemotherapy.Contrast-enhanced computed tomography subsequently demonstrated a localized dissection at the origin of the left external iliac artery with arterial occlusion.She was referred to vascular surgery and managed conservatively with cilostazol.This case highlights that external iliac artery dissection and occlusion should be considered in the differential diagnosis of persistent lower-extremity sensory or exertional symptoms following pelvic lymphadenectomy.In robot-assisted surgery, the absence of tactile feedback and the substantial force exerted by robotic instruments may increase the risk of unrecognized vessel compression.Careful handling of the iliac vessels and early vascular imaging should be considered when postoperative symptoms persist.