Argon beam coagulation during caesarean section

Authors


*Correspondence: Dr S. Lurie, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel.

Case report

A 44-year-old parous woman was scheduled for an elective caesarean section for fetal macrosomia, with bilateral tubal ligation. Her antenatal course had been uneventful. A Pfannenstiel incision was performed. A baby boy weighing 4.14 kg with Apgar scores of 9 and 10 at 1 and 5 minutes, respectively, was delivered. The placenta was removed manually. No bleeding was noted from the placental bed. The uterus was exteriorised and closed with a double layer of sutures. Substantial bleeding occurred from the uterine wound. Haemostasis was attempted with intravenous oxytocin, intrauterine methergine, direct manual uterine massage and multiple figure of eight sutures. Profuse bleeding persisted despite those measures. At that point, the Argon beam coagulator was used, with 60 W at 4 L/minute, to coagulate the entire uterine wound. The bleeding stopped. Bilateral tubal ligation was performed. Profuse bleeding occurred from the right uterine tube, which did not stop despite multiple sutures. Again the Argon beam coagulator was used to achieve haemostasis. The remainder of the operation was uneventful. Blood loss was estimated to be 1500 mL. The woman's haemoglobin concentration decreased from 11.4 to 9.4 g/dL. She did not receive a blood transfusion. Her coagulation tests were normal. The post-operative period was uneventful and she was discharged on the fifth post-operative day.

Discussion

The Argon beam coagulator is an electrosurgical coagulation device that concentrates electrical energy into a non-contact direct beam of Argon gas1,2. Contrary to the traditional electrosurgical coagulator, the Argon beam coagulator provides electrical energy that is distributed uniformly across the tissue in depth and area without direct contact1,2. Moreover, the blood is ‘blown away’ from the target site, no smoke is formed during coagulation, the eschar is formed homogeneously and there is little tissue damage with excellent haemostasis1,2. The Argon beam coagulator has been used in many types of operation, including hepatic, splenic, maxillofacial and gynaecological surgery, during laparoscopy and laparotomy, and also in anticoagulated patients3–6.

A MEDLINE search from 1966 to September 2001 (search terms argon, beam, coagulator) identified 71 items, only one of which described Argon beam coagulation during caesarean section. In that case, the Argon beam coagulator was used to achieve haemostasis of the placental bed after removal of a placenta accreta2. We report our successful experience with haemostasis of the external surface of the uterus during caesarean section using the Argon beam coagulator. Its use in our case avoided more radical treatments, such as ligation of the hypogastric arteries and hysterectomy, procedures that carry a considerable rate of intra-operative complications and post-operative morbidity. The Argon beam coagulator may be another useful treatment in severe obstetric haemorrhage.

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