Safety and Efficacy of a Surgeon-Prepared Gelatin Hemostatic Agent Compared with FloSeal for Hemostasis in Laparoscopic Partial Nephrectomy

Guzzo, Thomas J.; Pollock, Richard A.; Forney, Allen; Aggarwal, Piyush; Matlaga, Brian R.; Allaf, Mohamad E.

doi:10.1089/end.2008.0535

Cited by 27 publications

(20 citation statements)

References 15 publications

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“…A recent survey on the current practice for urologist performing LPN, confirmed that HAs were used in 77.4% of cases and were mainly represented by gelatine‐matrix thrombin (Floseal), fibrin gel (Tisseel), BSA (Bioglue), oxidised regenerated cellulose (Surgicel) or combinations of these. The overall postoperative bleeding requiring transfusion and urine leakage rates were 2.7% and 1.9%, respectively . Triaca et al.…”

Section: Discussionmentioning

confidence: 93%

“…A recent survey on the current practice for urologist performing LPN, confirmed that HAs were used in 77.4% of cases and were mainly represented by gelatine-matrix thrombin (Floseal), fibrin gel (Tisseel), BSA (Bioglue), oxidised regenerated cellulose (Surgicel) or combinations of these. The overall postoperative bleeding requiring transfusion and urine leakage rates were 2.7% and 1.9%, respectively [4][5][6][7]. Triaca et al [8] were the first to describe the use of thrombin sealant with no renal artery occlusion in OPN and concluded that PN with no temporary arterial occlusion is technically feasible and safe.…”

Section: Discussionmentioning

confidence: 99%

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National prospective study on the use of local haemostatic agents during partial nephrectomy

et al. 2013

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Objective• To assess the use of local haemostatic agents (HAs) in a prospective multicentre large series of partial nephrectomies (PNs). Patients and Methods• Prospective National Observational Registry on the Practices of Haemostasis in Partial Nephrectomy (NEPHRON): the study was conducted in 54 French urological centres from 1 June to 31 December 2010.• In all, 570 consecutive patients undergoing a PN were enrolled in this study in a prospective manner. The data was collected prospectively via an electronic case-report form: five different sheets were included for preoperative, perioperative, postoperative and follow-up data respectively. Information related to haemostasis was analysed. Results• The median patient age was 60 years and the mean (range) tumour size was 3.68 (0.19-15) cm.• An HA was primarily used in 71.4% of patients, with a statistically significant difference among surgical approaches (P = 0.024).• In 91.8% of cases, a single use of a HA was sufficient for achieving haemostasis. The HA was used either alone (13.9%) or in association with sutures (80.3%).• One or more additional haemostatic action(s) was needed in 12.3% of the cases.• When comparing patients who received a HA with those who did not receive a HA, there was no statistical difference between the groups for tumour size (P = 0.542), collecting system drainage (P = 0.538), hospital stay (P = 0.508), operation time (P = 0.169), blood loss (P = 0.387) or transfusion rate (P = 0.713). Conclusion• HAs are widely used by urologists during PN. Progress is needed for standardising HA application, especially for the timing of application. For the time being, the role of the HA in nephron-sparing surgery is still to be evaluated.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

National prospective study on the use of local haemostatic agents during partial nephrectomy

et al. 2013

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“…Furthermore, no impact was seen on operative time, ischemia time, or other negative outcomes. Consequently, the authors suggested that omitting these agents during RAPN could be safe and cost-effective1415. The absolute cost per case may vary between $100–$500, depending on the agent used.…”

Section: Discussionmentioning

confidence: 99%

The use of Haemostatic Agents does not impact the rate of hemorrhagic complications in patients undergoing partial nephrectomy for renal masses

Abu-Ghanem

Dotan

Kaver

et al. 2016

Sci Rep

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Hemostatic agents(HAs) have gained increasing popularity as interventions to improve perioperative haemostasis and diminish the need for allogeneic red cell transfusion(PBT) despite a paucity of data supporting the practice. The aim of the current study is to examine the efficacy of HAs in reducing the rate of hemorrhagic complications during partial nephrectomy(PN). Data on 657 patients, who underwent elective PN between 2004–2013, were analyzed. The impact of HAs and SURGICEL was evaluated by comparing four sequential groups of patients: Group1 = Sutures alone, Group2 = sutures and HA, Group3 = sutures and SURGICEL, Group4 = both HA and SURGICEL. Complications included post-operative urinary leak(UL), PBT rate, delayed bleeding and post-operative renal failure. Results showed that the use of HAs did not engender a statistically significant difference in overall complications rate. Specifically, the addition of HAs did not reduce the rate of PBT, delayed bleeding or UL. Further analysis revealed that patients who received SURGICEL had significantly higher PBT rate and higher prevalence of UL cases. Addition of HAs to SURGICEL had no effect on the rate of these complications. In the current study, the use of HAs during open and laparoscopic PN did not reduce the rate of negative outcomes. Adequate suture renorrhaphy may be sufficient to prevent hemorrhagic complications.

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“… No Floseal ® (laparoscopic suturing) (68) Guzzo 2009 [ 27 ] Floseal ® (19) Operating and warm ischaemia times, blood loss, postoperative transfusion rate, length of hospital stay, and costs Similar safety and efficacy for the two alternatives, and Gelfoam ® was less expensive than Floseal ® . Gelfoam ® (21) Koni 2012 [ 28 ] Floseal ® (11) Differences in complications The use of haemostatic agents significantly reduced postoperative complications. Among haemostatic agents, TachoSil ® provided the best benefits in terms of postoperative complications.…”

Section: Resultsmentioning

confidence: 99%

Use of Floseal®, a human gelatine-thrombin matrix sealant, in surgery: a systematic review

2014

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BackgroundSurgical bleeding can be associated with an increased risk of morbidity and mortality across all surgical areas. Thus, numerous products have been developed to achieve haemostasis. A flowable haemostatic matrix such as Floseal® can quickly and reliably stop bleeding across the full spectrum of bleeding scenarios. The aim of this study was to systematically review clinical and economic evidence regarding the use of Floseal® in surgical procedures.MethodsAn extensive literature search was conducted in PubMed, EMBASE, and the Cochrane Library over the period spanning 2003–2013 to identify publications related to Floseal® use in all types of surgical procedures. Case reports and case series studies were excluded.ResultsA total of 27 papers met the selection criteria and were analysed. In the studies, blood loss and the time to achieve haemostasis were the most reported outcomes used to assess the efficacy of Floseal®. The majority of published studies (64%) examined the use of Floseal® compared with conventional methods (such as electrocautery or suturing). The remaining 36% of the studies evaluated the use of Floseal® compared with other haemostatic agents, such as Surgicel®, Gelfoam®, and Hemostase®. FloSeal® has been demonstrated to be an efficacious method in surgical procedures to reduce the time to achieve haemostasis, the frequency of intra- and postoperative bleeding, and the length of hospital stay, among other primary outcomes, resulting in less consumption of health resources.ConclusionsThe majority of the selected studies confirmed that Floseal® showed improvements over other haemostatic agents in achieving haemostasis and reducing blood loss.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2482-14-111) contains supplementary material, which is available to authorized users.

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Safety and Efficacy of a Surgeon-Prepared Gelatin Hemostatic Agent Compared with FloSeal for Hemostasis in Laparoscopic Partial Nephrectomy

Cited by 27 publications

References 15 publications

National prospective study on the use of local haemostatic agents during partial nephrectomy

National prospective study on the use of local haemostatic agents during partial nephrectomy

The use of Haemostatic Agents does not impact the rate of hemorrhagic complications in patients undergoing partial nephrectomy for renal masses

Use of Floseal®, a human gelatine-thrombin matrix sealant, in surgery: a systematic review

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