Which procedure would necessitate the use of a cell saver device?

A cell saver device is used in surgical procedures that have a higher risk of significant blood loss, allowing for the recovery and reinfusion of the patient's own blood. In the context of the procedures listed, abdominal aortic aneurysm (AAA) repair is associated with substantial vascular manipulation and potential blood loss due to the proximity of major blood vessels and the aorta.

During an AAA repair, the surgeon may encounter extensive bleeding, which makes it critical to have a means of conserving and utilizing the patient's blood. The cell saver collects blood lost in the surgical field, processes it, and reinfuses it back into the patient, thereby minimizing the need for allogeneic blood transfusions and reducing the risk of transfusion-related complications.

In contrast, the other procedures, while they do have their own risks, typically have lower blood loss expectations. For instance, coronary artery bypass grafts can involve significant blood loss as well, but operational protocols may vary in terms of transfusion practices and use of a cell saver depending on the specific case. Appendectomy and gallbladder removal are generally considered lower-risk procedures for blood loss, making the use of a cell saver unnecessary in most cases.

Thus, the use of a cell saver device is most warranted during an abdominal