Control of Hemorrhage During Laparoscopy

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Control of Hemorrhage
During Laparoscopy

Hemorrhage secondary to laparoscopic procedures, particularly tubal sterilization, can frequently be controlled via the laparoscope with electrocoagulation and/or Silastic banding of the bleeding points.

The purpose of this operation is to control bleeding.

Physiologic Changes. Pelvic hemorrhage is controlled.

Points of Caution. If bleeding occurs adjacent to a vital structure, the Silastic band technique is preferred over the electrocoagulation technique. The electrocoagulation technique is adequate, however, for control of hemorrhage on the Fallopian tube.

Care must be taken to ensure that hemorrhage is controlled prior to withdrawing the instruments from the abdomen.

Technique

In most instances when the surgeon is using either electrocoagulation or the Silastic band technique, hemorrhage can be controlled without laparotomy. The bleeding areas are identified through the laparoscope.

The laparoscopy grasping tongs of the Silastic band instrument are used to grasp the bleeding area to draw it into the Silastic band applier and to push a Silastic band over the bleeding pedicles. This band acts as a suture ligature and stops the bleeding. Two or more such bands can be applied to all bleeding areas.

If the surgeon prefers electrocoagulation for control of hemorrhage, the 3-mm grasping forceps is used to electrocoagulate the bleeding stumps of the proximal or distal Fallopian tube.

After electrocoagulation or application of a Silastic band, the area should be irrigated with a small amount of sterile saline solution and observed for several minutes to be sure that all bleeding has stopped.