Intraoperative Bleeding and Hemostasis in Endoscopic Surgery.

Jose Daniel Lozada Leon, MD, Jose Antonio Licona Ortiz, MD, Clodoalda Durthley Lozada Leon, MD

Sanatorio Santa Monica, Cuernavaca., Morelos, Mexico.

INTRODUCTION
The aim of this video is to present some important aspects in the management of intraoperative bleeding and hemostasis in endoscopic surgery, focusing on the inherent risk of each patient’s treatment history in pre-existing disease in relation to anatomical vascular territory and technical aspects.

Intraoperative bleeding, known as sudden leakage of vascular territory hematic content, which is exempt from any surgical procedure, there solution is hemostasis, consider as the major surgical aspect upon which depent the postoperative good outcome of patients.

The best way to reduce the risk of intraoperative bleeding is always to identify and correct potential causes of coagulopathy from preoperatively.

METHODS AND PROCEDURES
We report the incidence of intraoperative bleeding in one hundred consecutive laparoscopic surgeries, with special emphasis on the following: surgeon- assistant- anesthesiologist-coordination, close hemodynamic monitoring, prevent hypothermia, empty and add ports, use of high-volume automatic insufflator, introduce gauze, make compression, gentle suction, use of 10 mm suction cannula , washed-sucking maneuver, use of forceps clamps, surgical stapling, use of electrocautery units, resolution of bleeding and if is inability to inhibit bleeding and if the patient present hemodynamic instability it is necessary conversion to open surgery.

RESULTS
we report in this serie 12% incidence of bleeding, endoscopic control of bleeding of 98%, conversion to conventional surgery 2% and 5% of patients required blood transfusion, there was no mortality in this series.

CONCLUSION
1 .- The best way to treat intraoperative bleeding is to avoid it.
2 .- This situation continues to be stressful for the surgical team so it’s important to stay calm and good coordination
3 .- If working in a complex vascular territory is recommended prior to have an absolute vascular control .
4 .- The need to design laparoscopic instruments such as tweezers hemostatic bulldogs and laparoscopic Satinsky clamps

Session: Poster Presentation

Program Number: P631