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

## TL;DR

A patient developed severe pulmonary embolism after robotic hysterectomy despite following standard blood clot prevention measures.

## Contribution

Highlights the need for reevaluating thromboprophylaxis duration after minimally invasive gynecologic surgery.

## Key findings

- A patient experienced severe pulmonary embolism 19 days after surgery despite postoperative VTE prophylaxis.
- Current VTE prevention measures for minimally invasive gynecologic surgery may be insufficient.
- Thromboprophylaxis duration beyond hospital discharge remains an open question.

## Abstract

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

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.

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

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.

•We experienced a case of severe pulmonary embolism after a robotic total hysterectomy.•The case was treated perioperatively with anti-thrombotic prophylaxis.•The question remains whether thromboprophylaxis should be continued long after discharge from the hospital.

We experienced a case of severe pulmonary embolism after a robotic total hysterectomy.

The case was treated perioperatively with anti-thrombotic prophylaxis.

The question remains whether thromboprophylaxis should be continued long after discharge from the hospital.