Translaparoscopic hemostasis with microfibrillar collagen in lieu of laparotomy. A report of two cases

Laparoscopy has become an integral part of the gynecologist's armamentarium in the diagnosis and treatment of abdominopelvic conditions. Although it was originally designed only for diagnostic purposes, experienced laparoscopists are performing an increasing amount of surgery translaparoscopically, thereby avoiding the need for major surgical procedures, such as laparotomy. Evaluation of a source of active bleeding is a common indication for diagnostic laparoscopy. A suspected uterine perforation during dilatation and curettage requires such an investigation in most instances when active bleeding is suspected. We report two instances in which laparoscopic visualization identified a source of continuous bleeding at the uterine serosal surface following perforation during curettage. Translaparoscopic application of a microcrystalline collagen hemostatic substance (Avitene) was used to control bleeding at the hemorrhagic site and thus avoid a major abdominal surgical procedure.