Sigit Purbadi,

Oncology Gynaecology Division

Department of Obstetrics and Gynecology
Dr. Cipto Mangunkusumo Hospital Jakarta
Medical Faculty of University of Indonesia
At the end of this session participant
Have full knowledge of surgical bleeding
type.
Have knowledge of hemostatic
technique/Surgical Bleeding
Management
Competency to manage surgical bleeding
Blood loss volume and risk of
transfusion
Can we reduce the blood loss?

The answer : Must be Yes!

 How to reduce the blood loss?
Well known the bleeding risk factor

Well known the pelvic blood supply

Have an adequate skill

Medications intervention
 Risk factor for bleeding
Pelvic adhesion
Pelvic infection
Pregnant
Blood coagulation defect
Inadequate skill/Competency level
Surgical accident
What we have to do if the bleeding occur?

Blood evacuate

Simple pressure

Permanent bleeding control

 Haemostatic technique

The vessels should be clear from

surrounding tissue
Using two ligated and cutting
Using haemostatic clam, cutting and knot
tying
Using electro coagulation (ligasure)
 Haemostatic Technique for
Diffuse bleeding
Electrocoagulation with fulguration mode
Electrocoagulation with fibrin gel
Electrocoagulation with Laser CO2
Elektrocoagulation Argon Beam
 Pilihan pengobatan
Uterine Artery Embolization (UAE)
APC/ABC
Uterine artery clamping
Vein injury Beeding control
The last alternative
 Summary
Know well the Anatomy

Adequate skill

Adequate surgical instrument

Be a confident surgeon