A 66-year-old gravida 3, para 3 woman with hypertension, diabetes mellitus, presented for surgical staging of recurrent stage IB cervical carcinoma, initially treated with chemoradiotherapy (cisplatin 40 mg/m², completed October 2021). Surveillance liquid-based cytology was negative, but pelvic MRI revealed a 6.5×4.5 cm hematometra and diffuse infiltrative mass from the right cervix to fundus, with right parametrial invasion, pelvic sidewall abutment, and presumed hematocolpos. Multiple enlarged pathologic lymph nodes were noted in right iliac, aortocaval, and retrocaval regions, without upper abdominal metastases. PETCT confirmed uterine involvement and nodal metastases in left common iliac, aortocaval, and paraaortic spaces.

Robotic XI paraaortic lymphadenectomy was performed. An enlarged paraaortic lymph node was identified and dissected meticulously in the correct plane using monopolar scissor cautery, with third-arm-assisted traction and counter-traction for exposure. Minor bleeding was controlled via cauterization.

At the node’s base, dense adhesions to the IVC—exacerbated by tumor-induced fibrosis and nodal enlargement— resulted in a small (0.5 cm) laceration during careful blunt dissection.

Immediate gentle pressure was applied using surgical mesh to tamponade without exacerbating vessel trauma. Dissection continued to expose the site fully. TachoSil fibrin sealant patch was applied with moderate pressure while proceeding with monopolar hook dissection. Upon pressure release, bleeding recurred; the injury was secured by grasping with a robotic grasper. Multiple figure-of-eight 4-0 Prolene sutures achieved primary hemostasis, confirmed visually. Lymph node excision was completed, followed by TachoSil reapplication.

Adherent nodal–IVC interfaces require precise identification of an avascular plane. Gentle handling with noncrushing graspers is essential, and abrupt release of pressure should be avoided to prevent re-bleeding due to sudden reperfusion. Adequate exposure of both the injury site and the surrounding area is critical prior to repair. Suture reinforcement should be performed following clear identification of the defect. A fibrin sealant patch (e.g., TachoSil) should be applied with gentle pressure, and the site should be carefully inspected to ensure complete hemostasis. This stepwise approach helps minimize morbidity.