Introduction/Background Iatrogenic major vascular injury during laparoscopic gyneco-oncologic surgery is a rare but potentially fatal complication. Major vascular injury has been reported in less than 1% of cases, however, this injury can be fatal. Injuries to the aorta, vena cava inferior (VCI), external, and internal iliac arteries, and veins are the most common sites of major vascular damage during gynecologic surgery.

Results A 66-year-old female patient was diagnosed with endometrioid type grade 2 endometrial cancer. MRI confirmed more than 50% of myometrial invasion, and no presence of suspicious lymph nodes or cervical involvement was observed. Laparoscopic staging surgery was planned for the patient with a BMI of 31 and no additional comorbidities. During para-aortic lymphadenectomy, we encountered VCI injury causing massive bleeding at the level of the aortic bifurcation. This video presentation demonstrates the laparoscopic repair of a VCI injury that resulted in the loss of approximately three units of blood pack. We repaired the hole on VCI with 5/0 prolene sutures and did not convert to laparotomy. Pre-operative hemoglobin level was 13.9 mg/dl. The patient tolerated the bleeding well during surgery and we completed the surgery successfully, post-operative hemoglobin level was 9.1 gr/dl and the patient was discharged on day 3 with oral Fe+2 uneventfully.

Conclusion VCI is most commonly injured during a right paraaortic lymphadenectomy. In such a situation, applying pressure to the bleeding point must be the first and immediate intervention. Following cessation of massive bleeding, the surgeon should evaluate the laparoscopic repairability of the vascular injury. Small injuries may be easily controlled and resolved with pressure. However, large defects may bleed massively. In these circumstances, Allis clamps, Statisnsiky vascular clamps, and Bulldog clamps might be potentially helpful. After the visualization of the hole, it should be repaired with sutures.

Disclosures we declare that we have no conflict of interest