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483 Retroperitoneal bleeding management during laparoscopic lymphadenectomy
  1. J Ribeiro and
  2. S Testa
  1. Hospital Erasto Gaertner, Brazil


Introduction Minimally invasive surgery (MIS) still an evolving technique and it has been used progressively more for complex procedures. At the same time, complications management using MIS is also evolving and conversion is becoming less common. It’s important to master different strategies to approach complications, specially bleeding because this is one of the major causes of conversion. It’s our objective to demonstrate different strategies to control venous and arterial bleeding during MIS.

Method Using a series of videos we present the 4 most used techniques of bleeding control: compression, coagulation, clipping and suturing.

Results Simple compression can control the majority of small retroperitoneal bleeding, sometimes associated with hemostatic agents. Bleeding from small tributary vessels can be controlled using bipolar energy. Another option is the use of clips, especially when there isn’t a safe place to use bipolar energy or there is a defect in the vessel wall. It is important to avoid clipping large portions of the vessel wall, as well as to avoid adicional damage. For larger lacerations the suturing techniques is best approach. Before performing the suture, it is important to achieve control of the surgical area. In robotic assisted laparoscopy the same principles must be followed. Instead all the approaches shown, there is some cases that laparoscopic bleeding control is not possible and conversion is needed.

Conclusion It is possible to achieve bleeding control by MIS in different ways. Each technique can be appreciated in different situations. It is very important to the surgeon to master all bleeding control strategies.

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