Seckin Timur K, Friedlich Nicole E, Murphy Clare, Chu Amanda, Alden Dmitri, Seckin Tamer A
Burnett School of Medicine at Texas Christian University, Fort Worth, TX. (Mr. Seckin and Ms. Friedlich).
University of Massachusetts Amherst (Ms. Murphy).
CRSLS. 2024 Dec 30;11(4). doi: 10.4293/CRSLS.2024.00044. eCollection 2024 Oct-Dec.
There is a risk of iatrogenic vascular injuries during robotic-assisted laparoscopic excision of diaphragmatic endometriosis. Although studies are limited, the first reported case of a suprahepatic inferior vena cava (IVC) injury during robotic diaphragmatic endometriosis excision was successfully treated using a fibrin sealant patch, preventing exsanguination and conversion to laparotomy.
A 36-year-old female with a history of recurrent catamenial pneumothorax and two prior video-assisted thoracoscopic surgeries to treat diaphragmatic endometriosis presented to our clinic with right-sided shoulder pain and a chest tube in place. She underwent robotic-assisted laparoscopic pelvic and bowel resection for severe endometriosis and liver mobilization to repair the right diaphragm. During liver mobilization, the surgeon inadvertently caused a 2-mm defect in the suprahepatic IVC, resulting in 250 mL of venous hemorrhage. Hemostasis was achieved using robotic compression of a fibrin sealant patch, avoiding conversion to laparotomy. The chest tube was maintained throughout surgery and postoperatively for drainage. The patient experienced no thrombotic complications.
This case illustrates the successful use of a fibrin sealant patch to control a major vascular injury in the robotic-assisted laparoscopic setting. While fibrin sealant patches are Food and Drug Administration-approved for soft tissue hemostasis, their application in major vascular repairs, including the IVC, is off-label. The blood loss (250 mL) and absence of thrombotic events highlight the safety and efficacy of the fibrin sealant patch. Further investigation is warranted to establish the efficacy of fibrin sealants in the repair of major vascular injuries in robotic-assisted and traditional laparoscopic surgeries.
在机器人辅助腹腔镜下切除膈子宫内膜异位症的过程中，存在医源性血管损伤的风险。尽管相关研究有限，但首例机器人辅助膈子宫内膜异位症切除术中肝上腔静脉损伤的病例通过使用纤维蛋白密封剂贴片成功得到治疗，避免了大出血和中转开腹。
一名36岁女性，有复发性经期气胸病史，曾接受过两次电视辅助胸腔镜手术治疗膈子宫内膜异位症，因右侧肩痛且留置胸腔引流管前来我院就诊。她因严重子宫内膜异位症接受了机器人辅助腹腔镜盆腔和肠道切除术，并进行了肝脏游离以修复右侧膈肌。在肝脏游离过程中，外科医生不慎造成肝上腔静脉出现一个2毫米的缺损，导致250毫升静脉出血。通过机器人操作将纤维蛋白密封剂贴片压迫止血，避免了中转开腹。整个手术过程及术后均保留胸腔引流管用于引流。患者未出现血栓形成并发症。
本病例说明了在机器人辅助腹腔镜手术中成功使用纤维蛋白密封剂贴片控制重大血管损伤。虽然纤维蛋白密封剂贴片已获得美国食品药品监督管理局批准用于软组织止血，但其在包括腔静脉在内的重大血管修复中的应用属于超适应症使用。出血量（250毫升）以及未发生血栓形成事件凸显了纤维蛋白密封剂贴片的安全性和有效性。有必要进一步研究以确定纤维蛋白密封剂在机器人辅助和传统腹腔镜手术中修复重大血管损伤的疗效。
