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Malignant Disease:
Special Procedures

Staging of Gynecologic
Oncology Patients With
Exploratory Laparotomy

Subclavian Port-A-Cath 

Peritoneal Port-A-Cath

Application of Vaginal
Cylinders for Intracavitary
Radiation Therapy

Application of Uterine Afterloading Applicators
for Intracavitary Radiation Therapy  

Pelvic High-Dose Afterloader

Abdominal Injection of Chromic Phosphate
()

Supracolic Total Omentectomy

Omental Pedicle "J" Flap

Tube Gastrostomy

Total Vaginectomy

Radical Vulvectomy
With Bilateral Inguinal
Lymph Node Dissection

Reconstruction of the
Vulva With Gracilis Myocutaneous Flaps

Transverse Rectus
Abdominis Myocutaneous
Flap and Vertical Rectus
Abdominis Myocutaneous
Flap

Radical Wertheim
Hysterectomy With
Bilateral Pelvic Lymph
Node Dissection and With Extension of the Vagina

Anterior Exenteration

Posterior Exenteration

Total Pelvic Exenteration

Colonic "J" Pouch Rectal
Reservoir

Kock Pouch Continent Urostomy

Omental "J" Flap Neovagina

Ileocolic Continent Urostomy (Miami Pouch)

Construction of Neoanus
Gracilis Dynamic Anal
Myoplasty

Skin-Stretching System Versus Skin Grafting

Gastric Pelvic Flap for
Augmentation of Continent Urostomy or Neovagina

Control of Hemorrhage in Gynecologic Surgery

Repair of the Punctured
Vena Cava

Ligation of a Lacerated
Internal Iliac Vein and
Suturing of a Lacerated Common Iliac Artery

Hemorrhage Control in
Sacrospinous Ligament
Suspension of the Vagina

Presacral Space
Hemorrhage Control

What Not to Do in Case of Pelvic Hemorrhage

Packing for Hemorrhage
Control

Control of Hemorrhage
Associated With Abdominal Pregnancy

Repair of the Punctured Vena Cava

Technique

The surgeon is frequently faced with small circular defects in the wall of the inferior vena cava above the bifurcation caused by evulsion of the perforator vein entering the para-vena cava lymph nodes. Hemorrhage is copious and immediate. The first step in control of this hemorrhage is to apply pressure with the finger, the second step is to gain exposure by suctioning blood from the abdominal cavity, extending the incision, etc., and the third step is to obtain vascular instruments.

The small circular defect in the vena cave can be grasped with smooth vascular pickups.

A stainless steel hemoclip can be applied to the tented portion of the vena cava (VC). Excess blood should be washed from the area with saline.

The repaired puncture should be observed for several minutes. We have discontinued resuturing the incised peritoneum over the vena cava. The remaining aortic and vena cava lymphadenectomy should continue.

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