2025 Volume 41 Issue 2 Pages 49-53
Injuries to the external iliac vessels during total laparoscopic hysterectomy (TLH) often occur during lateral expansion of the uterine pia mater and pelvic lymph node dissection. In this case, we experienced external iliac vein injury during vaginal wall incision.
The patient, a 38-year-old woman, gravida four para four, had been treated for adenomyosis with LEP, but her pelvic pain worsened and she decided to undergo TLH.
During the right-to-left incision of the anterior vaginal wall before hysterectomy, the shaft of the monopolar slid against the anterior wall of the uterus, and the hook at the tip of the monopolar bounced to the left side and injured the left external iliac vein. Since there was severe bleeding from the injured area, we identified the bleeding site and grasped it with forceps. Then, two Z sutures were performed and hemostasis was achieved. Blood loss was 920 ml (without transfusion), and operating time was 219 minutes. The postoperative course was uneventful, and the patient was discharged on the fifth day.
In this case, the external iliac vein was unexpectedly damaged during incision of the anterior vaginal wall. Large vessel injuries can occur not only during perivascular procedures, but also accidentally during procedures away from the vessels. We believe that patients'invasiveness can be reduced by always being vigilant for large vessel injuries and, if they do occur, by reacting calmly and quickly stopping the bleeding.
