Laparoscopic myomectomy with intraoperative haemorrhage — emergency recognition and management station

Team-based emergency station: intraoperative haemorrhage during laparoscopic myomectomy, vasopressin and uterotonic escalation, conversion threshold and the safe conversion sequence, intrauterine balloon tamponade and interventional radiology as bridge, and structured handover. Includes assessor key and marking domains.

Prompt

You are the gynaecology registrar performing a laparoscopic myomectomy on a 36-year-old nullipara with a 10-week-size uterus and a dominant 8 cm posterior intramural fibroid. Vasopressin 20 IU in 80 mL normal saline has been injected into the myometrium overlying the fibroid and the anaesthetist has been informed. During enucleation along the pseudocapsule the uterus begins to bleed briskly, the anaesthetist reports the blood pressure has fallen to 88/52 mmHg with a heart rate of 110 bpm, and the suction canister shows approximately 600 mL of blood loss. The examiner will feed you a sequence of events.

Laparoscopic myomectomy with intraoperative haemorrhage — emergency management station

Station brief

Format. Emergency management station, approximately 12 minutes. You are the gynaecology registrar in theatre performing a laparoscopic myomectomy. The anaesthetist, the scrub nurse and a circulating nurse are with you. The consultant is in the next theatre and reachable within minutes. The assessor will run the clock and feed you a sequence of intraoperative events.^[1]

Candidate instruction. Lead the management of brisk intraoperative bleeding during laparoscopic myomectomy. Verbalise your actions, the uterotonic escalation, the conversion threshold, the role of intrauterine balloon tamponade and interventional radiology, and the structured handover to the consultant.^[1]^[2]

References3Show

[1]Balachandran A, Mishra RK, Effie AO, Raghunathan A, Mathew A, Archana S A systematic review and meta-analysis of efficacy of vasopressin as a vasoconstrictive and uterotonic drug in laparoscopic myomectomy J Minim Access Surg, 2024.PMID 39724600
[2]Kathopoulis N, Prodromidou A, Douligeris A, Diakosavvas M, Zacharakis D, Kypriotis K, Chatzipapas I, Grigoriadis T, Protopapas A Barbed Sutures Compared With Conventional Sutures During Laparoscopic Myomectomy: A Systematic Review and Meta-analysis Obstet Gynecol, 2024.PMID 39146537
[3]Devassy R, Devassy RR, de Wilde MS, Krentel H, Adlan A, Torres-de la Roche LA, De Wilde RL The Future of Minimal-Access Myoma Surgery with In-Bag Contained Morcellation J Clin Med, 2023.PMID 37297823

Laparoscopic myomectomy with intraoperative haemorrhage — emergency recognition and management station

Station brief

References3Show

[1]Balachandran A, Mishra RK, Effie AO, Raghunathan A, Mathew A, Archana S A systematic review and meta-analysis of efficacy of vasopressin as a vasoconstrictive and uterotonic drug in laparoscopic myomectomy J Minim Access Surg, 2024.PMID 39724600
[2]Kathopoulis N, Prodromidou A, Douligeris A, Diakosavvas M, Zacharakis D, Kypriotis K, Chatzipapas I, Grigoriadis T, Protopapas A Barbed Sutures Compared With Conventional Sutures During Laparoscopic Myomectomy: A Systematic Review and Meta-analysis Obstet Gynecol, 2024.PMID 39146537
[3]Devassy R, Devassy RR, de Wilde MS, Krentel H, Adlan A, Torres-de la Roche LA, De Wilde RL The Future of Minimal-Access Myoma Surgery with In-Bag Contained Morcellation J Clin Med, 2023.PMID 37297823