scholarly journals To clamp or not to clamp?

2020 ◽  
Author(s):  
Roderick Clark ◽  
Stacy Fan ◽  
Roshan Navaratnam ◽  
Nahid Punjani ◽  
Nicholas Power
Keyword(s):  
Blood Loss ◽  
Surgical Techniques ◽  
Control Technique ◽  
Vascular Control ◽  
Primary Analysis ◽  
Excessive Bleeding ◽  
Iliac Arteries ◽  
Estimated Blood Loss ◽  
Internal Iliac ◽  
Internal Iliac Arteries

Introduction: Radical prostatectomy (RP) is the gold-standard surgical treatment for men with clinically localized prostate cancer (PCa). Surgical techniques to minimize intra and post-operative complications are well established, but excessive bleeding during RP continues to be a concern. The objective of our study was to determine whether additional intraoperative temporary occlusion of the internal iliac arteries combined with a penile base tourniquet during open RP improves hemostasis. Methods: We conducted a retrospective chart review of 23 patients who underwent open RP between Jan 2014 to May 2016. Eight patients underwent open RP with additional clamping of the internal iliac arteries using bulldog vascular clamps combined with a penile base penrose drain tourniquet as temporary prostatic arterial and venous control during dorsal venous complex ligation and neurovascular bundle sparing. Our primary outcome was immediate and post-operative day 1 hemoglobin levels. Our main outcome was analyzed using Students t-test with equal variance. Results: We stratified participants by clamping type. Fifteen patients underwent no clamping and 8 patients had the combined temporary clamping. Primary analysis of estimated blood loss showed a reduction in average blood loss among individuals with vascular control technique versus usual technique (516 ml and 754 ml respectively, p= 0.021). There were no obvious intraoperative or postoperative complications noted that could have been attributable to the temporary vascular control techniques. Conclusion: Temporary vascular control with the addition of minor surgical techniques during open RP may improve an objective measure of blood loss immediately after surgery.

scholarly journals Abdominal Myomectomy for Huge Uterine Myomas with Intra-arterial Balloon Occlusion: Approach to Reduce Blood Loss

2019 ◽  
Vol 06 (S 01) ◽  
pp. S11-S21 ◽  
Author(s):  
Satoru Takeda ◽  
Tsuyoshi Ota ◽  
Hiroshi Kaneda ◽  
Yasuhisa Terao ◽  
Ryohei Kuwatsuru
Keyword(s):  
Blood Loss ◽  
Preoperative Assessment ◽  
Massive Bleeding ◽  
Subsequent Pregnancy ◽  
Balloon Occlusion ◽  
Iliac Arteries ◽  
Abdominal Myomectomy ◽  
Balloon Catheters ◽  
Internal Iliac ◽  
Internal Iliac Arteries

AbstractAbdominal myomectomy for a huge myomas, especially uterine cervical myoma, is difficult because of risks, such as intraoperative bleeding or injury to adjacent organs. Therefore, understanding of the positional relationships among a huge myoma, especially cervical or intraligamental myoma, and the vascular plexuses in the right and left cardinal ligaments is important for prevention of massive bleeding during myomectomy. While sufficiently performing preoperative assessment with pelvic examination, ultrasonography, magnetic resonance imaging (MRI), etc., surgeons should always keep in mind how they can reduce the blood loss volume, while safely and surely performing resections. For a cervical myoma of the uterus and giant uterine leiomyoma that leave no intrapelvic space and prevent palpation and identification of the uterine arteries and the internal iliac arteries, surgery can be performed safely by preoperatively placing balloon catheters in the internal iliac arteries. Hemostaic strategies for myomectomy and tips of subsequent pregnancy following myomectomy are also described.

scholarly journals Role of bilateral internal iliac artery ligation in severe obstetric and gynaecological hemorrhage

2018 ◽  
Vol 7 (3) ◽  
pp. 1090 ◽  
Author(s):  
Shashi Lata Kabra Maheshwari ◽  
Nisha Kumari ◽  
Syed N. Ahmad
Keyword(s):  
Success Rate ◽  
Iliac Artery ◽  
Internal Iliac Artery ◽  
Care Hospital ◽  
Artery Ligation ◽  
Iliac Arteries ◽  
Internal Iliac Artery Ligation ◽  
Internal Iliac ◽  
Internal Iliac Arteries

Background: Massive pelvic haemorrhage is a potentially lethal complication while undergoing obstetric and gynaecological surgery. The objective of this study was to study of role of bilateral internal iliac artery ligation in severe obstetric and gynaecological haemorrhage. It was a prospective interventional study carried out in a multi-speciality tertiary care hospital in New Delhi.Methods: Thirty-five patients (31 obstetric and 4 gynaecological) fulfilling the inclusion criteria over a period of 2 years were included in the study cohort after informed consent. After laparotomy, internal iliac arteries were exposed by incising the peritoneal fold between the infundibulo-pelvic and round ligaments. A number 1 silk suture and right-angled artery forceps were used to tie the internal iliac arteries approximately 1 inch below their origin. The success and complications of the procedure were analysed.Results: In the present study 31 out of 35 cases underwent BIIAL for obstetrical cause of haemorrhage and rest 4 for gynaecological cause. In 19 out of 31 patients, hysterectomy preceded or followed BILAL depending upon the clinical situation making a uterine salvation rate of 38.7%. The success rate of BIIAL was 67.7% in 31 obstetric cases. In the 4 gynaecological cases BILAL was done to arrest post-hysterectomy haemorrhage and success rate was 100%. Among 35 patients one patient died of haemorrhagic shock and 4 other died of full blown sepsis and MODS in surgical ICU. No significant procedure related complications were encountered.Conclusions: BILAL is a very effective procedure to control PPH and pelvic haemorrhage due to other causes and helps save the much precious lives and uteri. This procedure can always be tried where procedures like embolization are unavailable.

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