Laparoscopic repair of inferior vena caval injury using a chitosan-based hemostatic dressing.
BACKGROUND
Vena caval injury is a rare but serious complication of laparoscopic surgery, and often requires conversion to an open procedure. The current study investigated whether a vena caval injury could be repaired with a chitosan dressing laparoscopically.


METHODS
Six domestic swine were studied. A 4- to 5-mm circumferential incision was created in the inferior vena cava (IVC) and repaired laparoscopically with a chitosan dressing. Neither suture nor additional hemostatic techniques were used. The animals were killed at 30 minutes (n = 2) and at 1 week (n = 4) postoperatively for histopathological analysis.


RESULTS
All IVC injuries were successfully repaired laparoscopically using a single chitosan dressing application without recurrent hemorrhaging. Mean operative time was 6 minutes and the blood loss was approximately 55 mL. There was no evidence of clot formation in the repaired vessels. Histology showed that the chitosan dressing had partially degenerated into small particles with moderate chronic inflammatory response 1 week after repair.


CONCLUSIONS
Use of the chitosan-based hemostatic dressing is a simple and reliable technique to control serious hemorrhage from IVC injury during laparoscopic surgery.
Xie
Hua
H
Oregon Medical Laser Center, Providence St Vincent Medical Center, Portland, OR 97225, USA. hua.xie@providence.org
Teach
Jeffrey S
JS
Burke
Allen P
AP
Lucchesi
Lisa D
LD
Wu
Ping-Cheng
PC
Sarao
Rebecca C
RC
D000818:Animals; D001458:Bandages; D016063:Blood Loss, Surgical; D048271:Chitosan / Q000008:administration & dosage*; D004195:Disease Models, Animal; D006470:Hemorrhage / Q000628:therapy; D006488:Hemostasis, Surgical / Q000379:methods; D006490:Hemostatics / Q000008:administration & dosage*; D010535:Laparoscopy / Q000009:adverse effects*; D013552:Swine; D014682:Vena Cava, Inferior / Q000293:injuries* / Q000601:surgery
D006490:Hemostatics; D048271:Chitosan