Fibrin sealants and topical agents in hepatobiliary and pancreatic surgery: a critical appraisal

Abstract

In the following invited review, we discuss current literature describing the use of topical agents and fibrin sealants in liver and pancreas surgery. We summarize major contemporary clinical trials and their findings regarding the use of these agents in HPB surgery and provide evidence from the preclinical literature as to the translation of these products into the clinical arena.

A new technique for hepatic parenchymal transection using an articulating bipolar 5 cm radiofrequency device: results from the first 100 procedures

“…For open hepatectomy, in addition to the clamp and crush technique, various different techniques for PT have been described relying on a combination of vessel sealers, ultrasonic aspirators, advanced tissue coagulators, ablative technologies, staplers, and tissue sealants. [5][6][7][8][9][10][11][12][13][14][15][16][17] Due to the limitations of exposure, the number of different techniques used in laparoscopic liver resection is even more diverse, leading to the lack of standardization, inefficiency and increased costs. Acknowledging these challenges, we have been assessing a new articulating radiofrequency device for liver resection with the aim to simplify and facilitate parenchymal transection over the past 5 years.…”

An update on topical haemostatic agents in liver surgery: systematic review and meta analysis

“…Two classes of THA are currently available (Table ): A first group provides a matrix (M) for endogenous coagulation (collagen, cellulose or gelatine) without active components. A second group contains active components (fibrin sealants), mimicking endogenous coagulation . Fibrin sealants are component mixtures predominately comprised of fibrinogen (F) and activating agents, such as calcium chloride and thrombin (T): this necessitates intraoperative preparation and immediate application . …”

“…A few products combine both classes of THA in a ready‐to‐use device: a matrix (M) of human or animal collagen‐based material, which can be coated with additional active components to improve the haemostatic effect. These components, added in varying concentrations, commonly include fibrinogen (F), coagulation factors such as thrombin (T) and anti‐thrombolytic agents . These combined devices are also called “carrier‐bound fibrin sealants”.…”

“…Despite widespread THA use among liver surgeons – especially carrier‐bound fibrin sealants – as well as a flourishing literature, the level of evidence remains low .…”

In vitro Evaluation of Performance Properties of Sponge Hemostatic Dressings (Review)

“…During the analysis linear and surface density is identified [20][21][22]. The linear density of the sample М l (g/cm) is calculated according to the formula:…”