Management of presacral bleeding

Introduction and hypothesis The objective of this video is to demonstrate a variety of available techniques that can be used in the management of acute presacral bleeding. Methods In this video, we demonstrate different methods for the management of presacral bleeding utilizing a fresh frozen cadaver. Results Presacral bleeding is a potentially catastrophic complication that can be encountered during pelvic surgery, particularly sacrocolpopexy. Various techniques exist to achieve hemostasis in the event of uncontrolled bleeding. This video demonstrates some of the available methods that may be employed in the management of presacral bleeding. The methods demonstrated in this video include direct pressure, pelvic packing, gelatin matrix, bone wax, thumb tack, surgical clip, suture, oxidized regenerated cellulose, omental flap, electrocautery, muscle fragment welding, gelatin matrix combined with thrombin, and microporous polysaccharide spheres. Conclusion Familiarity with these techniques and product availability will aid in the management of acute presacral bleeding.