PMC8397578_01
Intraoperative view of the open right iliac vein (yellow oval), despite the injury no bleeding is seen due to the preperitoneal pressure of 12 mmHg.
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F1
Due to the preperitoneal CO2 pressure of 12 mmHg an active bleeding of the injured vein could not be seen (Figures 1, 2).
The preperitoneal pressure is increased to 14 mmHg; the intraluminal blood volume is now more compressed and a venous branch is visible through the injured lumen (black arrow).
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F2
Due to the preperitoneal CO2 pressure of 12 mmHg an active bleeding of the injured vein could not be seen (Figures 1, 2).
The defect is sutured (not shown) and additionally covered by a hemostatic patch (Veriset, Covidien).
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F3
In addition, a hemostatic patch (Veriset, Covidien) was applied (Figure 3).
The inguinal hernia is supplied with polypropylene mesh in double mesh technique (Bard, SoftMesh).
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F4
Then the preperitoneal pressure was reduced to 8 mmHg to check the stability of the suture, followed by mesh placement of a 15 x 12 cm large pore monofilament polypropylene mesh (Bard Soft Mesh), according to in-house standards and previously described by Weyhe D. et. al in double mesh technique without fixation (Figure 4).