Control of inferior vena cava injury during laparoscopic surgery using a double balloon-equipped central venous catheter: proof of concept in a live porcine model

Yukio Iwashita, Hiroki Uchida, Hiroomi Takayama, Michihiro Ichimanda, Katsuya Taniguchi, Hideki Kiguchi, Tetsumi Sakaguchi, Hajime Fujishima, Kunihiro Saga, Kazuhiro Tada, Takao Hara, Kiminori Watanabe, Teijiro Hirashita, Yuichi Endo, Masayuki Ohta, Masafumi Inomata

Research output: Contribution to journalArticle

Abstract

Background: Iatrogenic inferior vena cava (IVC) injury is a rare but potentially life-threatening complication during laparoscopic surgery. This experimental study aimed to assess the hemostatic ability of a new device, double balloon-equipped central venous (DB-CV) catheter, for IVC injury. Methods: The DB-CV catheter comprises a triple-lumen sphincterotome combined with two dilating balloons having a diameter of 25 mm. The experimental procedures were performed in five pigs. The DB-CV catheter was inserted via the right femoral vein. For the IVC occlusion test, correct placement of the balloons was confirmed by indocyanine green fluorescence imaging, and hemodynamic data were recorded. For the IVC injury test, a 3- to 4-mm circumferential incision was created in IVC, and hemostasis was initiated using balloon inflation 5 s after the injury. Results: Hemodynamic changes were minimal, with a 20 mmHg reduction in the mean arterial pressure because of IVC occlusion. All bleeding from IVC injuries was successfully temporarily stopped by direct balloon compression, with a mean time to hemostasis of 69 s and mean blood loss of 32 ml. Subsequently, the positioning of IVC injuries between two balloons made it possible to suture the injured IVC. Conclusions: Balloon occlusion using the DB-CV catheter provides a rapid temporal hemostatic effect and can overcome the serious condition of massive hemorrhage from IVC injuries.

Original languageEnglish
Pages (from-to)2397-2401
Number of pages5
JournalSurgical endoscopy
Volume32
Issue number5
DOIs
Publication statusPublished - May 1 2018

All Science Journal Classification (ASJC) codes

  • Surgery

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    Iwashita, Y., Uchida, H., Takayama, H., Ichimanda, M., Taniguchi, K., Kiguchi, H., Sakaguchi, T., Fujishima, H., Saga, K., Tada, K., Hara, T., Watanabe, K., Hirashita, T., Endo, Y., Ohta, M., & Inomata, M. (2018). Control of inferior vena cava injury during laparoscopic surgery using a double balloon-equipped central venous catheter: proof of concept in a live porcine model. Surgical endoscopy, 32(5), 2397-2401. https://doi.org/10.1007/s00464-017-5938-6