NARUS 2019: Vascular Injury Repair

Las Vegas, Nevada ( Dr. Rene Sotelo provided some of his knowledge and expertise on vascular injuries during urologic robotic surgeries. These frightening scenarios can occur in any surgery, whether open, laparoscopic, or robotic and in any level of complexity. It is therefore critical not to take any surgery lightly.

Words of wisdom were then presented by Dr. Sotelo. These included a discussion with the entire team to promote awareness of the procedural aspects in which complications are more likely to occur. Additionally, it is important to think outside of the abdomen and look for red flags, such as differences in opinions within the team, anxiety, fatigue, stress, and policy violation.  It is critical to promote healthy communication in the OR. Lastly, the surgeon should know how to prevent and treat all relevant potential complications, even if he is not the general surgeon.

Dr. Sotelo moved on to discuss practical management of intraoperative bleeding:
  1. The first step is to apply compression
  2. The increase of the pneumoperitoneum to 20 mm hg – this tremendously helps to reduce venous bleeding
  3. It is possible to use a rolled gauze sponge to tamponade or to grasp the arterial stump
  4. Have needle drivers ready, and rescue sutures on the table
  5. If possible improve the exposure and perform careful suction, as venous bleeding tends to increase with the loss of pneumoperitoneum.
In the next step, it is important to make a quick decision – whether robotic/laparoscopic repair is still possible or not. If it is not possible, conversion to open surgery should be done as soon as possible. A hemorrhage tray should always be available at request. It should be comprised of rescue sutures, lapra-Ty and clip appliers, and Hem-O-Lock clips and applier, two needle holders, Klein bulldogs, and Klein applicator, satinsky clamp, surgical, and bolsters.

Dr. Sotelo concluded his talk emphasizing how important the preparation for these scenarios are. It is essential to remain calm, take the surgeon’s ego out of the equation, and call for help when available.

Presented by: Rene Sotelo, MD, Professor of Clinical Urology, Keck Institute of Urology, Los Angeles, California

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at  2019 3rd Annual North American Robotic Urology Symposium (NARUS), February 8-9, 2018 - Las Vegas, Nevada, United States

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