Application Of Energy-based Technologies And Topical Hemostatic Agents In The Management Of Surgical Hemostasis

Abstract

Achieving intraoperative hemostasis is essential for excellent surgical outcomes. A variety of methods, ranging from mechanical tools and energy-based technologies to topical hemostatic agents, are available to the modern surgeon. Given that bleeding develops from different origins, from small discrete bleeding or venous oozing to arterial hemorrhage, different tools and agents have different efficacy in specific situations. In this article, we review the mechanism by which currently available hemostatic tools and agents stop bleeding and give recommendations for their use during surgery. Furthermore, the costs of the various methods are presented, allowing the provider to choose not only the most potent but also the most cost-effective treatment modality in each situation.

A multicentre, prospective, randomized, controlled trial comparing EVARREST™ fibrin sealant patch to standard of care in controlling bleeding following elective hepatectomy: anatomic versus non-anatomic resection

“…6 However segmental and non-anatomical resections can be technically challenging and can be associated with significant operative blood loss. 7 These factors, in addition to increasing evidence that transfusion of blood or blood derived products can be associated with significant patient morbidity and adverse oncological outcomes, 8,9 have resulted in a contemporary focus on reducing blood loss and eliminating transfusion requirement in all forms of hepatic surgery while expanding the eligibility of patients who can be considered for hepatic resection, particularly for cancer. 4 EVARREST™ Fibrin Sealant Patch (FP) is a means of treating hepatic parenchymal bleeding and was developed as an adjunctive topical haemostat to manage haemorrhage across a wide spectrum of bleeding challenges.…”

Article Commentary: Hemostats, Sealants, and Adhesives: A Practical Guide for the Surgeon

“…T HIS DOCUMENT IS specifically designed to assist the surgeon in the practical use of hemostats, sealants, and adhesives. Recent, sequential, comprehensive reviews of this topic have been provided by the author [1][2][3] and current reviews exist by others as well, [4][5][6][7] but the goal of this particular commentary is to create a guide that emphasizes the key points for everyday safe and successful application of these agents.…”

Patient‐centered blood management

“…These include techniques such as intraoperative blood recovery and acute normovolemic hemodilution . Energy‐based technologies, such as electrosurgery, harmonic scalpels, argon beam coagulation, and radiofrequency technology have also been used to aid in hemostasis . Interventions such as pharmacologic agents and topical hemostatic/sealant agents can also be utilized to minimize intraoperative blood loss.…”