Common ways to stop bleeding in laparoscopic surgery

The most common and widely used methods.  

A. Pressure method: When you can't quickly pinpoint the bleeding spot or if the wound is seeping, start with gauze pressure. It's a quick and effective approach.  

B. Ligation method: Suitable for blood vessels that are visible to the naked eye. When dealing with the cut end, directly tying it off is a relatively safe measure. This includes silk thread ligation, Hom-lock clamp closure, etc.  

C. Hemostatic forceps: When handling blood vessels, use hemostatic forceps to clamp small vessels, then decide whether to tie them off based on the situation.

The development of surgery is always accompanied by updates and iterations of instruments. Below are some common energy devices used for hemostasis in current surgeries.

A. Electrosurgical Devices

Used for anatomical tissue separation during surgery, they can both coagulate for hemostasis and cut tissue. The MAX setting is for cutting, while the MIN setting is for coagulation. Common types include electrosurgical hooks, electrosurgical spades, and electrosurgical knives.

B. Ultrasonic Scalpel

Coagulation mechanism: By applying mechanical energy to the tissue, it causes high-frequency vibrations within the tissue, generating heat through internal cellular friction, which breaks the hydrogen bonds in proteins, causing protein denaturation and coagulation.

Advantages:

- Minimal heat conduction, which helps avoid thermal injury;

- Produces little smoke, causing minimal impact on the surgical field;

- Can directly cut blood vessels with a diameter of 3 mm.

C. LigaSure

Also known as: Computer-controlled feedback bipolar electrosurgical system.

The LigaSure vessel sealing system uses real-time feedback and smart console technology to deliver high-frequency energy. Combined with pressure between the electrosurgical blades, it dissolves and denatures the collagen and fibrin in the vessel to be cut. The vessel walls fuse together, forming a clear band that achieves permanent lumen closure.

Advantages:

- Can seal vessels up to 7 mm in diameter;

- Minimal dissection needed for vessels in the tissue being sealed;

- The sealed band can withstand pressure more than three times normal human systolic pressure;

- Fast sealing, no smoke, doesn’t interfere with the surgical field;

- No unpleasant odor or carbonization during sealing, so no residual foreign objects like sutures or titanium clips are left;

- Local temperature remains low during sealing, minimal thermal spread, thermal conduction distance only 1.5–2 mm.

Hemostatic drugs mainly work by boosting the body's clotting factors or inhibiting anticoagulant factors to help blood clot and stop bleeding.

A. Drugs that act on the blood vessel walls

There’s adrenal chromaffin (Anluo Xue), phenylpropanolamine (Hemostop), vasopressin, and so on.  

For example, the vasoconstrictive effect of vasopressin can reduce blood flow in the mesentery, cause small arteries in the visceral vascular beds to constrict, and decrease liver blood flow, which can effectively treat esophageal variceal bleeding in patients with portal hypertension.

B. Drugs that act on platelets

Used less frequently, often in surgeries for hemophilia patients. I won’t go into too much detail here.

C. Drugs that act on the blood clotting system

Commonly used are fresh blood, fresh frozen plasma, fibrinogen preparations, thrombin preparations, and coagulation factor preparations.  

Injectable thrombin, also called batroxobin, works on both the intrinsic and extrinsic coagulation systems, activating prothrombin to form thrombin, promoting the clotting process, and helping to stop bleeding at the site of hemorrhage.  

It works well for stopping bleeding on surgical wounds. Besides injection, it can also be administered by spraying, orally, as an enema, or applied directly to the wound, except in cases of disseminated intravascular coagulation (DIC).

D. Drugs for the antifibrinolytic system

Common ones include 6-aminocaproic acid, aminocaproic acid, tranexamic acid, and protease inhibitors.

E. Topical hemostatic drugs

Commonly used ones include gelatin sponges, microfibrillar collagen hemostats, bone wax, thrombin, fibrin glue, and so on.

Hemostatic drugs are widely used for stopping bleeding during surgery, but it's important to note that drug-based hemostasis is only an auxiliary measure. The key is to locate the bleeding site and actively manage the bleeding vessels.

A. Definition: Under the guidance of endoscopy, ultrasound, CT, or X-ray, therapeutic catheters, injection needles, balloons, or other related instruments are introduced into organs, and local spraying or injection of hemostatic drugs, sclerosing agents, biological glue, chemical glue, etc., is performed for embolization treatment, or physical and chemical factors such as high-frequency current, laser, or microwave are applied to achieve the purpose of treating bleeding lesions.

B. Embolic materials: These can be autogenous materials (clots, fascia, muscle, etc.), absorbable or non-absorbable particulate materials, metal materials, microspheres, microcapsules, liposomes, and more.

C. Clinical applications: They have shown good hemostatic effects in cases like postpartum hemorrhage, traumatic splenic rupture, digestive tract ulcer bleeding, severe bladder bleeding, and retroperitoneal bleeding.

D. Pros and cons: The procedure is simple, minimally invasive, and recovery is fast.

Using anesthetic methods to lower a patient's blood pressure usually brings the mean arterial pressure down to 50–70 mm Hg (1 mm Hg = 0.133 kPa). The main goal is to reduce bleeding in the surgical field, improve surgical conditions, and decrease the amount of blood transfused.

The basic requirements for hemostasis: simple and practical (before, during, and after surgery); fast and long-lasting; non-toxic, without side effects, and does not induce thrombosis; does not increase the chance of infection and does not affect tissue healing.

As a junior surgeon, mastering these hemostatic methods is actually quite useful. As the saying goes, opportunity always favors the prepared.