Removal of the trocar

TTTS. Removal of the trocar

Once the desired level of amniotic fluid volume in the sac of the recipient twin is reached, the suction–irrigation trumpet is removed and the patient is alerted to the removal of the trocar. Trocar removal is monitored with ultrasound to detect bleeding from the anterior uterine wall or membrane detachment. 

If neither occurs, the incision is covered with a band-aid, steri-strips or dermabond to conclude the surgery. Bleeding from the anterior uterine wall may occur at any point during surgery, but most commonly after removal of the trocar. Bleeding is typically short-lived, and can usually be contained with external digital pressure over the incision site of approximately 5 minutes. 

Occasionally, bleeding may be of greater magnitude, requiring either longer compression time (10–15 minutes), or rarely a laparotomy and surgical myometrial hemostasis. Lateral tilting of the patient may also be helpful in managing bleeding from the anterior uterine wall.