Recombinant activated factor VII administration in a patient with congenital lack of factor VII undergoing laparoscopic hysterectomy: A case report

•Patients with lack of factor VIIa, suffering from abnormal uterine bleedings can be treated with laparoscopic hysterectomy.•Technique using bipolar coagulation and non-absorbable clips is safe and not time consuming.•Pre-operative loading with recombinant factor VIIa must be followed by prolonged supplementation in post-operative period.•We present suggested dosage and length of factor VIIa supplementation based on literature review and own experience. Case report of patient with congenital lack of factor VII, suffering from recurrent hematomas and massive menstrual bleedings resulting in severe anemia and multiple hospitalization. Patient was diagnosed with endometrial hyperplasia and not responding to hormonal treatment and substitution with recombinant factor VII was not effective to reduce the bleedings. This case describes successful laparoscopic technique of using bipolar coagulation and non-absorbable clips. We describe premedication and post-surgical management – which we had to modify from this found in very scarce literature. Despite previous vaginal deliveries without any complications during the puerperium, 20 days after the surgery patient presented with intraperitoneal bleeding after stopping rFVIIa therapy. It was treated medically without the need for re-laparoscopy. Laparoscopic surgery is possible in patients with lack and deficiency of FVIIa, but they need close post-operative surveillance and prolonged supplementation with recombinant FVIIa.