Objectives Intraoperative blood loss is a major contributing factor to morbidity and mortality in pelvic surgery. Therefore, the maintenance of haemostatic control is a crucial safety component.
Methods We performed a systematic review of the literature to identify current strategies to reduce blood loss in complex pelvic surgery.
Results This article reviews the current intra-operative strategies used to reduce bleeding. We discuss the surgical techniques for identifying the major pelvic arteries relevant to surgery. Once identified, various materials and equipment can be used to temporarily or permanently occlude these vessels with the aim of maintaining homeostasis. We review in which situations each option is best suited and the most appropriate apparatus for each approach. Correct surgical planning must also be determined to provide good visualisation of the pelvic field. Importantly, consideration must be given to the vascularity and size of the lesion, which can vary greatly depending on the pathology. This will further impact on planning and dictate visualisation and securing of key vascular structures prior to manipulation of the lesion.
Conclusions In summary, adequate identification, access and manipulation of the appropriate vasculature is essential for prevention and management of major blood loss in pelvic surgery. Temporary and permanent occlusion of pelvic arteries has been used in practice for some time to manage haemostasis, yet further information is required to provide a definitive time interval as currently this area of research remains overlooked.
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