The use of a fibrin tissue sealant during laparoscopic partial nephrectomy

Abstract

OBJECTIVETo assess the feasibility and efficacy of commercially available fibrin tissue sealant as a haemostatic agent and collecting-system sealant during hand-assisted laparoscopic partial nephrectomy (LPN). PATIENTS AND METHODSFifteen consecutive patients underwent LPN for enhancing renal masses suspicious for renal cell carcinoma via a transperitoneal approach and with the use of a handassistance device. Monopolar electrocauterization and argon-beam coagulation were initially used to slow bleeding from the resection site. Through a laparoscopic applicator, Tisseel TM fibrin sealant (Baxter Inc., Deerfield, IL) was applied to the transected partial nephrectomy bed while the surgeon's hand maintained adequate compression and partial haemostasis. No further haemostatic measures were required in any patient; the patients were evaluated for acute and delayed bleeding or urinary extravasation. RESULTSIn all cases electrocauterization and argonbeam coagulation followed by the application of Tisseel was successful in obtaining strict haemostasis of the surgical bed, with no evidence of bleeding during or after surgery on immediate and extended follow-up. In addition, there was no evidence during or after surgery of any urinary leak. There were no immediate or delayed complications in any of the patients; a short-term outpatient follow-up (12-60 weeks) revealed no additional problems. CONCLUSIONSConventional haemostatic measures of electrocauteriztion and argon-beam coagulation combined with commercial fibrin sealant allows successful haemostasis during LPN. In addition to haemostatic properties, fibrin sealants appear to have sealing properties that may help to prevent complications of urinary leakage by helping to seal or close the small defects in the urinary collecting system. The use of this compound may facilitate the ability of the urological laparoscopist during LPN.

Current applications of fibrin sealant in urologic surgery

“…The recent advent of minimally invasive techniques for nephron sparing surgery has resulted in widespread fibrin sealant use during laparoscopic partial nephrectomy today (12)(13)(14)(15). A recent survey of 193 members of the World Congress of Endourology discovered 68% of surgeons routinely utilized fibrin sealant to assist with hemostasis during laparoscopic partial nephrectomy (16).…”

Sangre, hemorragia, hematuria, urología

“…En la actualidad se mantienen vigentes muchas de aquellas técnicas sin que la preocupación por cuestiones hemorrágicas se haya disipado. Así lo demuestran trabajos recientes como los referentes al manejo del plexo de Santorini durante la prostatectomia radical 81 ; al estudio vascular renal para mejorar el acceso exangüe del riñón vía percutánea 82 ; o el diseño de nuevo instrumental para controlar el pedículo [83][84] , la superficie renal cruenta 85 y los alerones vasculares vesico-próstato-rectales 86 . Las nuevas tecnologías también buscan soluciones hemostáticas, destacando las energías láser 87 , argón 88 , radiofrecuencia 89 , crioterapia 90 y los electrobisturís armóni-cos 91 que eliminan tejido renal o prostático evitando en gran medida la hemorragia.…”

Bovine Serum Albumin Glutaraldehyde for Completely Sutureless Laparoscopic Heminephrectomy in a Survival Porcine Model

“…Hemostatic agents have been developed that enhance surgery by allowing a surgeon to more confidently maintain hemostasis during partial nephrectomy. [4][5][6] An agent independent of the clotting cascade is bovine serum albumin cross linked with glutaraldehyde (BSAG) (Bioglue; CryoLife, Inc., Kennesaw, GA). BSAG bonds with tissue surface proteins within the interstices of a wound and forms a pliable adherent covering.…”