A case of severe pulmonary embolism after total robotic hysterectomy despite venous thromboembolism prophylaxis as prescribed

Abstract

Introduction: We report the case of a patient who developed a severe pulmonary embolus postoperatively despite perioperative venous thromboembolism (VTE) prophylaxis as prescribed.

Presentation of case: A 50-year-old female patient underwent a robotic total hysterectomy for uterine fibroids. Her perioperative VTE risk was assessed as moderate, and compression and intermittent air compression stockings were used postoperatively until the morning following the surgery. The surgery was uneventful, and the patient was discharged on postoperative day 4. On postoperative day 19, the patient experienced rapid dyspnea and was diagnosed with a severe pulmonary embolus.

Discussion: Heparin, a tissue-type plasminogen activator, and a catecholamine were administered, and the patient recovered well.

Conclusion: VTE measures in minimally invasive gynecologic surgery are not well defined, and future thrombotic risk assessments specific to minimally invasive gynecologic surgery may be necessary.

Keywords: Case report; Prophylaxis; Robotic surgery; Total hysterectomy; Venous thromboembolism.