<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0300-9041</journal-id>
<journal-title><![CDATA[Ginecología y obstetricia de México]]></journal-title>
<abbrev-journal-title><![CDATA[Ginecol. obstet. Méx.]]></abbrev-journal-title>
<issn>0300-9041</issn>
<publisher>
<publisher-name><![CDATA[Federación Mexicana de Colegios de Obstetricia y Ginecología A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0300-90412020000600412</article-id>
<article-id pub-id-type="doi">10.24245/gom.v88i6.3864</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Lesión esplénica accidental en cirugía ginecológica laparoscópica asociada con la técnica de entrada. Reporte de un caso y revisión bibliográfica]]></article-title>
<article-title xml:lang="en"><![CDATA[Incidental splenic injury during laparoscopic gynecological surgery associated with the entry technique. A case report and literature review]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Saucedo-López]]></surname>
<given-names><![CDATA[Ángel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Topete-Estrada]]></surname>
<given-names><![CDATA[Rafael]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Saucedo-López]]></surname>
<given-names><![CDATA[Alfonso]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Gómez-Fernández]]></surname>
<given-names><![CDATA[Alejandra]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Instituto Mexicano del Seguro Social Hospital de Gineco-Pediatría 3A ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>Mexico</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Hospital General Dr. Manuel Gea González  ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>Mexico</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Instituto Mexicano del Seguro Social Hospital General Regional 36 ]]></institution>
<addr-line><![CDATA[ Puebla]]></addr-line>
<country>Mexico</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Instituto Mexicano del Seguro Social Hospital de Gineco-Pediatría 3A ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>Mexico</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2020</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2020</year>
</pub-date>
<volume>88</volume>
<numero>6</numero>
<fpage>412</fpage>
<lpage>419</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S0300-90412020000600412&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S0300-90412020000600412&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S0300-90412020000600412&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen:  ANTECEDENTES: Las lesiones accidentales del bazo durante la cirugía laparoscópica ginecológica son complicaciones raras, con gran repercusión en la morbilidad y mortalidad perioperatoria. La cirugía laparoscópica mediante compresión asistida y administración de hemostáticos es una opción viable en pacientes con lesiones esplénicas derivadas del acceso de los trocares.  CASO CLÍNICO:  Paciente de 48 años, con síndrome anémico secundario a trastornos (hipermenorrea y metrorragias) menstruales de seis meses de evolución, atendida en el departamento de Ginecología del Hospital General Dr. Manuel Gea González donde se clasificó con P0A0L1M0-C0O1E1I0N0 (FIGO 2011). Se decidió la histerectomía laparoscópica con salpingooforectomía bilateral. Durante el procedimiento quirúrgico tuvo sangrado activo, dependiente de la pared esplénica. Se ejerció compresión del sitio sangrante y se aplicó Surgicel® (producto hemostático absorbible-Ethicon), con adecuada hemostasia. La paciente evolucionó satisfactoriamente y fue dada de alta sin contratiempos.  CONCLUSIÓN: Existen pocos reportes de lesiones esplénicas accidentales en cirugía ginecológica laparoscópica. La parte más peligrosa es la introducción de la aguja de Veress y del trócar, que pueden provocar lesiones viscerales o a vasos sanguíneos. Las pacientes con lesiones esplénicas accidentales deben ser tratadas por un equipo multidisciplinario.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract:  BACKGROUND: Incidental spleen injuries during gynecological laparoscopic surgery are rare complications that have a major impact on perioperative morbidity and mortality. Laparoscopic management through assisted compression and haemostatic products has been a recommended option in patients who have splenic lesions secondary to the path of laparoscopic trocars.  CLINICAL CASE: 48-year-old patient with anemic syndrome secondary to 6-month-old menstrual disorders. It is protocolized in the Department of Gynecology of the Hospital Dr. Manuel Gea González where it is classified P0A0L1M0 - C0O1E1I0N0 (FIGO 2011). It is proposed for laparoscopic hysterectomy with bilateral salpingophrectomia. In the surgical act there is active bleeding dependent on splenic wall. It is compressed from the bleeding site and Surgicel® (absorbable hemostatic product - Ethicon) is applied, presenting hemostasis. The patient evolved successfully and left without incident.  CONCLUSION:  There are few documented reports of incidental splenic injuries in laparoscopic gynecological surgery. The most dangerous part of laparoscopy is the introduction of the Veress needle and the trocar, where visceral lesions or blood vessels may occur. Timely diagnosis of these complications is important for proper treatment. Incidental splenic injuries should be treated by a multidisciplinary team.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Lesión accidental]]></kwd>
<kwd lng="es"><![CDATA[cirugía laparoscópica ginecológica]]></kwd>
<kwd lng="es"><![CDATA[complicaciones laparoscópicas]]></kwd>
<kwd lng="es"><![CDATA[lesiones de entrada por trocar]]></kwd>
<kwd lng="es"><![CDATA[lesión esplénica]]></kwd>
<kwd lng="en"><![CDATA[Incidental injury]]></kwd>
<kwd lng="en"><![CDATA[Gynecological laparoscopic surgery, Laparoscopic complications, Trocar entry injuries, Spleen injury]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Tarik]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Fehmi]]></surname>
<given-names><![CDATA[C.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Complications of gynaecological laparoscopy--a retrospective analysis of 3572 cases from a single institute]]></article-title>
<source><![CDATA[J Obstet Gynaecol]]></source>
<year>2004</year>
<volume>24</volume>
<numero>7</numero>
<issue>7</issue>
<page-range>813-6</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Rieder]]></surname>
<given-names><![CDATA[JM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Differences in left and right laparoscopic adrenalectomy]]></article-title>
<source><![CDATA[JSLS]]></source>
<year>2010</year>
<volume>14</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>369-73</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Vázquez-Frías]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Prevention and treatment of abdominal wall bleeding complications at trocar sites: review of the literature]]></article-title>
<source><![CDATA[Surg Laparosc Endosc Percutan Tech]]></source>
<year>2009</year>
<volume>19</volume>
<page-range>195-7</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Salcido]]></surname>
<given-names><![CDATA[FJC]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Complicaciones de la laparoscopia ginecológica en un servicio de biología de la reproducción]]></article-title>
<source><![CDATA[Ginecol Obstet Mex]]></source>
<year>2008</year>
<volume>76</volume>
<numero>7</numero>
<issue>7</issue>
<page-range>386-91</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Delgado-Gomis]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
</person-group>
<source><![CDATA[Complicaciones de la cirugía laparoscópica: Cir Esp]]></source>
<year>2001</year>
<volume>69</volume>
<page-range>330-6</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Deziel]]></surname>
<given-names><![CDATA[DJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Complications of laparoscopic cholecystectomy: a national survey of 4292 hospitals and analysis of 77604 cases]]></article-title>
<source><![CDATA[Am J Surg]]></source>
<year>1993</year>
<volume>165</volume>
<page-range>9-14</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Baasgard]]></surname>
<given-names><![CDATA[SE.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Major vascular injury during gynecologic laparoscopy. Report of case and review of published cases]]></article-title>
<source><![CDATA[Acta Obstet Gynecol Scand]]></source>
<year>1989</year>
<volume>68</volume>
<page-range>283-5</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Voyles]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[A practical approach to laparoscopic cholecystectomy]]></article-title>
<source><![CDATA[Am J Surg]]></source>
<year>1991</year>
<volume>161</volume>
<page-range>365-70</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ponsky]]></surname>
<given-names><![CDATA[JL.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Complications of laparoscopic cholecystectomy]]></article-title>
<source><![CDATA[Am J Surg]]></source>
<year>1991</year>
<volume>161</volume>
<page-range>393-5</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Hyness]]></surname>
<given-names><![CDATA[SR]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Venous gas embolism during Gynaecologycal laparoscopy]]></article-title>
<source><![CDATA[Can J Anaesth]]></source>
<year>1992</year>
<volume>39</volume>
<page-range>748-9</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Seller]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[La anestesia en cirugía laparoscópica]]></article-title>
<person-group person-group-type="editor">
<name>
<surname><![CDATA[Delgado]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
</person-group>
<source><![CDATA[Cirugía laparoscópica para cirujanos generales]]></source>
<year>1995</year>
<publisher-loc><![CDATA[Madrid ]]></publisher-loc>
<publisher-name><![CDATA[Acirhospe]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Malcolm]]></surname>
<given-names><![CDATA[G.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age]]></article-title>
<source><![CDATA[Int J Gynecol Obstet]]></source>
<year>2011</year>
<volume>113</volume>
<page-range>3-13</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bohm-Velez]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[AIUM practice guideline for the performance of ultrasound of the female pelvis]]></article-title>
<source><![CDATA[J Ultrasound Med]]></source>
<year>2014</year>
<volume>33</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>1122-30</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<article-title xml:lang=""><![CDATA[Endometrial intraepithelial neoplasia. Committee Opinion No. 631. American College of Obstetricians and Gynecologists]]></article-title>
<source><![CDATA[Obstet Gynecol]]></source>
<year>2015</year>
<volume>125</volume>
<page-range>1272-8</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Benoist]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
</person-group>
<source><![CDATA[Worldwide prevalence of anaemia 1993-2005. Base de datos mundial sobre la anemia de la OMS]]></source>
<year>2008</year>
<publisher-loc><![CDATA[Ginebra ]]></publisher-loc>
<publisher-name><![CDATA[Organización Mundial de la Salud]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Saidi]]></surname>
<given-names><![CDATA[MH]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Complications and cost of Multipunture laparoscopy]]></article-title>
<source><![CDATA[Gynaecol Endosc]]></source>
<year>1994</year>
<volume>3</volume>
<page-range>85</page-range></nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Espadas]]></surname>
<given-names><![CDATA[LF.]]></given-names>
</name>
</person-group>
<source><![CDATA[Manual de asistencia al paciente politraumatizado]]></source>
<year>1997</year>
<edition>2</edition>
</nlm-citation>
</ref>
<ref id="B18">
<label>18</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Buntain]]></surname>
<given-names><![CDATA[WL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Sphenorrhaphy: changing concepts for the traumatized spleen]]></article-title>
<source><![CDATA[Surgery]]></source>
<year>2007</year>
<volume>86</volume>
<page-range>748-60</page-range></nlm-citation>
</ref>
<ref id="B19">
<label>19</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Artigas]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Cirugía conservadora en las lesiones esplénicas. Valoración de 60 casos]]></article-title>
<source><![CDATA[Cir Esp]]></source>
<year>1985</year>
<volume>29</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>663-8</page-range></nlm-citation>
</ref>
<ref id="B20">
<label>20</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[García-Gutiérrez]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Valvuloplastia de Toupet en la hernia hiatal deslizante y en la incompetencia del esfínter esofágico inferior]]></article-title>
<source><![CDATA[Rev Cubana Cir]]></source>
<year>2005</year>
<volume>24</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>585-601</page-range></nlm-citation>
</ref>
<ref id="B21">
<label>21</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Valls]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Algunas consideraciones sobre la esplenectomía]]></article-title>
<source><![CDATA[Rev Cubana Cir]]></source>
<year>2007</year>
<volume>26</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>49-59</page-range></nlm-citation>
</ref>
<ref id="B22">
<label>22</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Danforth]]></surname>
<given-names><![CDATA[DH]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Incidental splenectomy a review of the literature and New York Hospital experience]]></article-title>
<source><![CDATA[Ann Surg]]></source>
<year>2006</year>
<volume>183</volume>
<page-range>124-9</page-range></nlm-citation>
</ref>
<ref id="B23">
<label>23</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Brill]]></surname>
<given-names><![CDATA[AI]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Fundamentals of Peritoneal Access]]></article-title>
<source><![CDATA[J Am Assoc Gynecol Laparosc]]></source>
<year>2003</year>
<volume>10</volume>
<page-range>287-97</page-range></nlm-citation>
</ref>
<ref id="B24">
<label>24</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Munro]]></surname>
<given-names><![CDATA[MG]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Laparoscopic access: complications, technologies, and techniques]]></article-title>
<source><![CDATA[Curr Opin Obstet Gynecol]]></source>
<year>2002</year>
<volume>14</volume>
<page-range>36-74</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
