Management of Aberrant Vasculature During Hysterectomy of Bicornuate Uterus

Abstract

Video Objective Demonstrate laparoscopic management of patient with unanticipated anomalous vasculature and recovery from potentially catastrophic hemorrhage during laparoscopic hysterectomy. Setting Woman with bicornuate uterus and history of multiple cesarean sections on right uterine horn undergoing total hysterectomy in a tertiary care center. Interventions Extensive dissection in attempt to identify anatomic landmarks resulting in subsequent partial ligation of major artery of unknown origin. Subsequent intraoperative hemorrhage managed with mass transfusion protocol, vascular clamps, and ultimately incorporation of the artery into an angle stitch during vaginal cuff closure. Conclusion Maintaining a mental framework and strategy of approaching surgical cases from known to unknown is key to successful management of cases that deviate from the “norm.”