Oncology Patients With
Cylinders for Intracavitary
of Uterine Afterloading Applicators
for Intracavitary Radiation Therapy
Injection of Chromic Phosphate
Omental Pedicle "J"
With Bilateral Inguinal
Lymph Node Dissection
Vulva With Gracilis Myocutaneous Flaps
Flap and Vertical Rectus
Bilateral Pelvic Lymph
Node Dissection and With Extension of the Vagina
"J" Pouch Rectal
Omental "J" Flap
Continent Urostomy (Miami Pouch)
Gracilis Dynamic Anal
System Versus Skin Grafting
Pelvic Flap for
Augmentation of Continent Urostomy or Neovagina
of Hemorrhage in Gynecologic Surgery
of the Punctured
of a Lacerated
Internal Iliac Vein and
Suturing of a Lacerated Common Iliac Artery
Suspension of the Vagina
Not to Do in Case of Pelvic Hemorrhage
Associated With Abdominal Pregnancy
Ligation of a Lacerated Internal
and Suturing of a
Lacerated Common Iliac Artery
Laceration of a common iliac vein or artery can occur during insertion
of the trocar and sleeve with laparoscopy or can occur with lymph node
dissection for cancer.
METHODS COMMON TO BOTH LIGATION AND SUTURING
The most common site for laceration of the
common iliac artery is generally on the right side, as shown
here, because most surgeons are right-handed and insert the laparoscopic
trocar with the right hand. At the bottom, the internal iliac
(hypogastric) vein is shown lacerated, with copious bleeding
coming from both sites.
The first step any surgeon should utilize
is placing the finger over the laceration of the artery or vein.
Note the proximity of the right ureter to both the right common
iliac artery and the right common iliac vein.
LIGATION OF A LACERATED INTERNAL ILIAC VEIN
Every laparotomy kit contains
sponge sticks. Sponge sticks can be used for proximal and distal
pressure against the lacerated vessel, whether it be the internal
iliac vein, as shown here, or the common iliac artery, as shown
in Figure 2.
Blood flow through the open
vessels must be controlled. Do not attempt to suture a large
blood vessel while copious volumes of blood are flowing.
Ligation of a lacerated vein
can be more difficult than suturing of a lacerated artery.
The internal iliac vein can be tied off without sequela. Here,
DeBakey vascular clamps are placed proximal and distal on the
vein laceration. The vein is tied off at the proximal and distal
ends with synthetic absorbable suture. Collateral venous drainage
will develop between the lower extremity and the ligated internal
SUTURING OF A LACERATED COMMON ILIAC ARTERY
Sponge sticks can also be
used to control hemorrhage from a lacerated right common iliac
artery. The artery must be repaired with suture. Blood flow
must be controlled. Suturing an open artery is inaccurate and
Sponge sticks are always available
in laparotomy kits. Often, proper vascular instruments are
not. It is a serious mistake to use Kelly, Ochsner, or Kocher
clamps on large arteries or veins that need to be sutured.
Figure 6 illustrates the proper
way to repair a common iliac artery. DeBakey vascular clamps
are placed proximal and distal to the site. When the bleeding
ceases, a proper closure is made in the transverse plane of
the vessel with 5-0 synthetic monofilament permanent suture
on a cardiovascular needle. The 5-0 Prolene with a cardiovascular
needle frequently comes in double-tipped needle at both ends
of the suture. This allows a running suture that everts rather
than inverts the suture line in the artery. Inversion may produce
eddy currents that may cause blood clots.