Bleeding at Trocar Site (inferior epigastric injury):
- Use Carter-Thomason to place a simple interrupted at the trocar site to ligate the bleeding artery.
- Place foley through the trocar site, inflate the bulb in the abdomen, and pull tight up against the abdominal wall. If this stops or slows the bleeding, then continue with surgery with foley in place. Once procedure is complete, loosen the foley to see if artery clotted off.
- Extend skin incision and dissect down to fascia. Through figure of 8 or additional sutures to ligate the vessel.
Bladder repair:
Per Dr. Flemming, Urology: - 2-0 vicryl in running fashion of mucosa and muscular layer, then an overlying imbricating layer with 2-0 vicryl (especially if >2cm in length per uptodate).
- Leave foley in place for no longer than 1 week for a cystotomy of dome with no ureteral injury. Give single dose of 250-500mg Cipro at time of foley removal.
Bowel repair:
- For small sharp injury/perforation, use 3-0 surgilon suture in running or interrupted fashion, single layer. Be sure to include both serosal and mucosal layers in repair.
(Per Dr. Petty)
- For superficial thermal injury/serosal tear, 3-0 vicryl imbricating stitch over injury.
Large vessel laceration during Davinci:
- Grasp across vessel laceration with Maryland or similar grasper, davinci will maintain grasper closed once you step away from console.
- Through assist port, place traditional laparoscopic grasper (Maryland) across vessel and lock grasper.
- Undock Davinci and open abdomen/Call vascular surgery if needed.
*Brader had a small IVC laceration that he placed 2 surgiflo and applied pressure with raytec placed through the port.
Bladder trocar injury during TVT placement:
- Per Bennett, leaving foley in place for 4 days, then perform retrograde cystogram before removing the foley.
Urinary Retention after TVT:
- If significant retention after TVT, take back to pull down sling within 1 week of initial surgery. Or, wait until after 6 weeks for sling removal.
(Bennett)