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Hickman DA, Pawlowski CL, Sekhon UDS, Marks J, Gupta AS. Biomaterials and Advanced Technologies for Hemostatic Management of Bleeding. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2018; 30:10.1002/adma.201700859. [PMID: 29164804 PMCID: PMC5831165 DOI: 10.1002/adma.201700859] [Citation(s) in RCA: 265] [Impact Index Per Article: 44.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 06/18/2017] [Indexed: 05/03/2023]
Abstract
Bleeding complications arising from trauma, surgery, and as congenital, disease-associated, or drug-induced blood disorders can cause significant morbidities and mortalities in civilian and military populations. Therefore, stoppage of bleeding (hemostasis) is of paramount clinical significance in prophylactic, surgical, and emergency scenarios. For externally accessible injuries, a variety of natural and synthetic biomaterials have undergone robust research, leading to hemostatic technologies including glues, bandages, tamponades, tourniquets, dressings, and procoagulant powders. In contrast, treatment of internal noncompressible hemorrhage still heavily depends on transfusion of whole blood or blood's hemostatic components (platelets, fibrinogen, and coagulation factors). Transfusion of platelets poses significant challenges of limited availability, high cost, contamination risks, short shelf-life, low portability, performance variability, and immunological side effects, while use of fibrinogen or coagulation factors provides only partial mechanisms for hemostasis. With such considerations, significant interdisciplinary research endeavors have been focused on developing materials and technologies that can be manufactured conveniently, sterilized to minimize contamination and enhance shelf-life, and administered intravenously to mimic, leverage, and amplify physiological hemostatic mechanisms. Here, a comprehensive review regarding the various topical, intracavitary, and intravenous hemostatic technologies in terms of materials, mechanisms, and state-of-art is provided, and challenges and opportunities to help advancement of the field are discussed.
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Affiliation(s)
- DaShawn A Hickman
- Case Western Reserve University School of Medicine, Department of Pathology, Cleveland, Ohio 44106, USA
| | - Christa L Pawlowski
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, Ohio 44106, USA
| | - Ujjal D S Sekhon
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, Ohio 44106, USA
| | - Joyann Marks
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, Ohio 44106, USA
| | - Anirban Sen Gupta
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, Ohio 44106, USA
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Laparoscopic partial nephrectomy without intracorporeal suturing. Surg Endosc 2015; 30:1585-91. [PMID: 26162423 DOI: 10.1007/s00464-015-4382-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 06/26/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND Partial nephrectomy has gained wider acceptance as a surgical technique in treating small renal tumors. Laparoscopic partial nephrectomy (LPN) still remains a technically demanding surgery to this day. We present our technique of laparoscopic partial nephrectomy, one that is performed without intracorporeal suturing. METHODS We performed LPN on 31 patients with localized renal parenchymal tumor (stage T1). The procedures were done from September 2009 to March 2015 at the Kaohsiung Medical University Hospital and the Kaohsiung Municipal Ta-Tung Hospital. Our technique involves the covering of renal defect layer by layer with FloSeal, Tisseel and a fat pad after monopolar coagulation. RESULTS Thirty-one patients were included in this study. Mean patient age was 53 years old (range 39-70). Mean tumor size was 2.9 cm (range 1.8-6.3). Mean RENAL nephrometry score was 5.3 (range 4-7). The average operation time was 188 min (range 120-290), and the average warm ischemic time was 19.0 min (range 9-26). Mean estimated blood loss was 171 ml (range 10-650), with no postoperative bleeding among the total 31 patients. No recurrent tumors were identified at a mean follow-up of 29 months postoperatively. The mean change in eGFR was 6.5 (ml/min/m2). CONCLUSION Laparoscopic partial nephrectomy is a feasible surgical method for most patients with stage 1 tumor. Our technique has shown to reduce warm ischemic time significantly and provide patients with excellent functional outcomes without affecting oncological results. With this technique, surgeons can perform LPN with more efficiency and with fewer complications.
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Ploussard G, Haddad R, Loutochin O, Bera R, Cabrera T, Malibari N, Scarlata E, Derbekyan V, Bladou F, Anidjar M. A combination of hemostatic agents may safely replace deep medullary suture during laparoscopic partial nephrectomy in a pig model. J Urol 2014; 193:318-24. [PMID: 25046623 DOI: 10.1016/j.juro.2014.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE We assessed whether a combination of the fibrin tissue adhesive Tisseel® (human fibrinogen and thrombin) plus the hemostatic matrix FloSeal® (bovine derived gelatin matrix/human thrombin) could safely replace the conventional deep medullary suture without compromising outcomes. MATERIALS AND METHODS Laparoscopic mid pole and one-third partial nephrectomy was performed on the right kidney of 12 female pigs. The only difference between the 2 groups of 6 pigs each was the use of a fibrin tissue adhesive plus hemostatic matrix combination in group 2 instead of the deep medullary running suture in control group 1. Renal scans and angiograms were performed at baseline and before sacrifice at 5-week followup. Retrograde in vivo pyelogram was also done. RESULTS No significant difference was seen in operative parameters or postoperative course between the groups. Renal scans revealed a statistically insignificant trend toward greater uptake loss in group 1 and angiograms showed 3 major vessel occlusions in that group. No active bleeding was detected. Those 3 kidneys had significantly poorer postoperative uptake on renal scan than that of other kidneys (18.6% vs 39.4%, p = 0.013). Only 1 small asymptomatic pseudoaneurysm was noted in group 1. No urine leakage was found in either group. No major vessel occlusion, pseudoaneurysm or urinary complications developed in group 2. CONCLUSIONS Even after deep one-third partial nephrectomy FloSeal with concurrent Tisseel appeared sufficient to control major medullary vascular injuries and replace the deep medullary conventional suture without compromising operative outcomes. The potential advantages seen during functional and vascular examinations by decreasing the risk of unnecessary segmental vessel occlusion need further clinical evaluation.
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Affiliation(s)
- Guillaume Ploussard
- Department of Urology, Jewish General Hospital and Departments of Radiology, Nuclear Medicine and Pathology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Richard Haddad
- Department of Urology, Jewish General Hospital and Departments of Radiology, Nuclear Medicine and Pathology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Oleg Loutochin
- Department of Urology, Jewish General Hospital and Departments of Radiology, Nuclear Medicine and Pathology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Rahul Bera
- Department of Urology, Jewish General Hospital and Departments of Radiology, Nuclear Medicine and Pathology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Tatiana Cabrera
- Department of Urology, Jewish General Hospital and Departments of Radiology, Nuclear Medicine and Pathology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Nouf Malibari
- Department of Urology, Jewish General Hospital and Departments of Radiology, Nuclear Medicine and Pathology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Eleonora Scarlata
- Department of Urology, Jewish General Hospital and Departments of Radiology, Nuclear Medicine and Pathology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Vilma Derbekyan
- Department of Urology, Jewish General Hospital and Departments of Radiology, Nuclear Medicine and Pathology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Franck Bladou
- Department of Urology, Jewish General Hospital and Departments of Radiology, Nuclear Medicine and Pathology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada
| | - Maurice Anidjar
- Department of Urology, Jewish General Hospital and Departments of Radiology, Nuclear Medicine and Pathology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada.
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Peng HT, Shek PN. Novel wound sealants: biomaterials and applications. Expert Rev Med Devices 2014; 7:639-59. [DOI: 10.1586/erd.10.40] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Kilty SJ, Al‐Hajry M, Al‐Mutairi D, Bonaparte JP, Duval M, Hwang E, Tse D. Prospective clinical trial of gelatin‐thrombin matrix as first line treatment of posterior epistaxis. Laryngoscope 2013; 124:38-42. [DOI: 10.1002/lary.24240] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/16/2013] [Accepted: 05/16/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Shaun J. Kilty
- Department of Otolaryngology–Head and Neck SurgeryThe University of OttawaOttawa Canada
- The Ottawa HospitalOttawa Canada
- The Ottawa Hospital Research Institute (OHRI)Ottawa Canada
| | - Mohammad Al‐Hajry
- Department of Otolaryngology–Head and Neck SurgeryThe University of OttawaOttawa Canada
- The Ottawa HospitalOttawa Canada
| | - Dakheelallah Al‐Mutairi
- Department of Otolaryngology–Head and Neck SurgeryKing Abdulaziz Medical CityJeddah Saudi Arabia
| | - James P. Bonaparte
- Department of Otolaryngology–Head and Neck SurgeryThe University of OttawaOttawa Canada
- The Ottawa HospitalOttawa Canada
| | - Melanie Duval
- Department of Otolaryngology–Head and Neck SurgeryThe University of OttawaOttawa Canada
- The Ottawa HospitalOttawa Canada
| | - Euna Hwang
- Department of Otolaryngology–Head and Neck SurgeryThe University of OttawaOttawa Canada
- The Ottawa HospitalOttawa Canada
| | - Darren Tse
- Department of Otolaryngology–Head and Neck SurgeryThe University of OttawaOttawa Canada
- The Ottawa HospitalOttawa Canada
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Duarte A, Coelho J, Bordado J, Cidade M, Gil M. Surgical adhesives: Systematic review of the main types and development forecast. Prog Polym Sci 2012. [DOI: 10.1016/j.progpolymsci.2011.12.003] [Citation(s) in RCA: 168] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Choe CH, L’Esperance JO, Gudeman SR, Auge BK. Tubeless Percutaneous Nephrolithotomy. Urolithiasis 2012. [DOI: 10.1007/978-1-4471-4387-1_52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Percutaneous nephrolithotomy (PCNL) is the procedure of choice for removing large, complex, and/or multiple renal calculi. Since its first description in 1976, PCNL techniques and equipment have evolved to maximize procedural efficacy, safety, and reproducibility. We reviewed current literature from January 2004 to November 2009 using Medline search regarding PCNL instrumentation and technology. Additional equipment discovered during the review process without published Medline evidence was summarized from manufacturer brochures and data. Included in this review are summaries of intracorporeal lithotriptors and accessory equipment, stone manipulation devices, PCNL tract sealants, and a digital rigid nephroscope. The evolution of these devices from their predecessors has increased the instrumentation options for the treating urologist and may represent more effective technology for the percutaneous treatment of large renal stones.
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Affiliation(s)
- Joseph W Pugh
- Department of Urology, University of Florida, Gainesville, FL, USA
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Pick DL, Kolla SB, Mucksavage P, Louie MK, Sountoulides P, Kaufmann O, Olamendi S, Kaplan A, Huynh V, Ortiz-Vanderdys C, Truong HP, Said SA, Andrade L, Tongson-Ignacio J, McDougall EM, Clayman RV. Sprayed Fibrin Sealant as the Sole Hemostatic Agent for Porcine Laparoscopic Partial Nephrectomy. J Urol 2011; 185:291-7. [DOI: 10.1016/j.juro.2010.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Indexed: 11/27/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Adam Kaplan
- University of California-Irvine, Orange, California
| | - Victor Huynh
- University of California-Irvine, Orange, California
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Sileshi B, Achneck H, Ma L, Lawson JH. Application of energy-based technologies and topical hemostatic agents in the management of surgical hemostasis. Vascular 2010; 18:197-204. [PMID: 20643029 DOI: 10.2310/6670.2010.00015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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.
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Affiliation(s)
- Bantayehu Sileshi
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
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Chen ML, Tomaszewski JJ, Matoka DJ, Ost MC. Management of urine leak after laparoscopic cyst decortication with retrograde endoscopic fibrin glue application and ureteral stent placement. J Endourol 2010; 25:71-4. [PMID: 20942685 DOI: 10.1089/end.2010.0286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Urine leakage is an uncommon complication after renal cyst decortication that typically resolves with adequate drainage. With prolonged large volume urine leakage from a perinephric drain, however, consideration for open surgical repair must be taken into account. We present the successful management of persistent urine leakage after laparoscopic cyst decortication with endoscopic retrograde fibrin glue injection and ureteral stent placement.
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Affiliation(s)
- Mang L Chen
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA
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Chierigo P, Rahmati M, Lazzarotto M, Brotza D, Bernabei M, Franzolin N. Conservative treatment of persistent calyceal fistula after tumor excision. Case report and clinical remarks. Urologia 2010. [DOI: 10.1177/039156031007700308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Nowadays, ultrasounds allow to discover accidentally a large number of renal small tumors. So, radical nephrectomy, which years ago was considered as the gold standard, is rarely required. Today, nephron sparing surgery is often prescribed for renal masses smaller than 4 cm. Its most frequent complication is calyceal fistula. It can be prevented exploring carefully the surgical surface, and suturing any opening. It can heal over within a few days or some weeks, so it can be a trouble for both the patient and the surgeon. A complete urinary drainage, obtained with an ureteral stent and an open bladder catheter, helps heal. Recently, it has become common practice to spread synthetic or biological tissue sealants over the surgical surface, to improve hemostasis. These surgical glues have also been used to repair calyceal openings, with conflicting results. Methods We performed left renal tumor excision (3.5 × 3 cm) in a 72-years-old man, during temporary renal artery occlusion with surface hypothermia. We placed intraoperatively an ureteral stent. The visual examination of the surgical cavity did not reveal any calyceal opening. We electrocauterized it and stuffed it with FloSeal. Surgical edges were free from illness. After 5 days urinary leakage from the drainage tube increased. Pyelography showed a calyceal fistula. A further stent was placed, with no results. Bladder catheter was kept open for about 2 months. Urinary leakage stopped 34 days after surgery. Results Urinary leakage increased when the catheter was removed, and stopped only after many days of complete urinary drainage. Conclusions The conservative treatment of a calyceal fistula must be considered a still effective therapy, also in difficult cases, provided that a complete and long-lasting urinary drainage is carried out.
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Affiliation(s)
- Paolo Chierigo
- Unità Operativa Complessa di Urologia, Ospedale di Schio, Vicenza
| | - Mojtaba Rahmati
- Unità Operativa Complessa di Urologia, Ospedale di Schio, Vicenza
| | | | - Davide Brotza
- Unità Operativa Complessa di Urologia, Ospedale di Schio, Vicenza
| | | | - Nicola Franzolin
- Unità Operativa Complessa di Urologia, Ospedale di Schio, Vicenza
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Pace G, Saldutto P, Vicentini C, Miano L. Haemostatics in surgery and our experience in the enucleoresection of renal cell carcinoma. World J Surg Oncol 2010; 8:37. [PMID: 20462437 PMCID: PMC2876157 DOI: 10.1186/1477-7819-8-37] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Accepted: 05/12/2010] [Indexed: 12/19/2022] Open
Abstract
Background 30 patients, with T1 renal cell carcinomas (RCC) who underwent open enucleoresection of the tumour, were randomized to the use of a topical haemostatic agent (Floseal) or to an infrared-sapphire coagulator (ISC), to compare their efficacy in achieving haemostasis. Methods: Successful intra-operative haemostasis, intra- and post-operative bleeding, operative time, hospital discharge were evaluated. Results Statistically higher rates of successful haemostasis and shorter time-to-haemostasis (8,1 vs 12,9 min) were observed in the FloSeal group (p < 0.001 both). Patients operative time was not different between Group 1 vs 2 (58.7 ± 12 vs 62.4 ± 15; p > 0.05). The average blood loss during surgery was less (60 +/- 25.5 mL) for the FloSeal group than for the ISC group (85 +/- 40.5 mL) (p < 0.05). Postoperative blood loss was 25 +/- 5 mL and 40 +/- 45 mL for Floseal and ISC respectively, (p < 0.05). Length of the postoperative hospital discharge was 2.5 +/- 1.2 days for FloSeal group and 3.5 +/- 1.3 for the Group 2 (p < 0.05). No major immediate or delayed complications were observed in either Groups. Conclusions The use of Floseal and ISC offer a safe and efficacy haemostasis in the enucleoresection of RCC. Moreover, our results show a less intra-operative and post-operative blood loss as well as a shorter time to haemostasis of Floseal in respect to ISC.
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Affiliation(s)
- Gianna Pace
- Department of Surgical Sciences, University of L'Aquila, San Salvatore Street, Palace 6 A, Coppito, 67100 L'Aquila, Italy.
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Ramanathan R, Leveillee RJ. A Review of Methods for Hemostasis and Renorrhaphy After Laparoscopic and Robot-assisted Laparoscopic Partial Nephrectomy. Curr Urol Rep 2010; 11:208-20. [DOI: 10.1007/s11934-010-0107-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Rane A, Rimington PD, Heyns CF, van der Merwe A, Smit S, Anderson C. Evaluation of a Hemostatic Sponge (TachoSil®) for Sealing of the Renal Collecting System in a Porcine Laparoscopic Partial Nephrectomy Survival Model. J Endourol 2010; 24:599-603. [DOI: 10.1089/end.2009.0453] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Abhay Rane
- Department of Urology, East Surrey Hospital, Redhill, United Kingdom
| | - Peter D. Rimington
- Department of Urology, Eastbourne General Hospital, Eastbourne, United Kingdom
| | - Chris F. Heyns
- Department of Urology, University of Stellenbosch and Tygerberg Hospital, Tygerberg, South Africa
| | - Andre van der Merwe
- Department of Urology, University of Stellenbosch and Tygerberg Hospital, Tygerberg, South Africa
| | - Shaun Smit
- Department of Urology, University of Stellenbosch and Tygerberg Hospital, Tygerberg, South Africa
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L’Esperance JO, Marguet CG, Walters RC, Sung JC, Auge BK, Stroup SP, L’Esperance AH, Albala DM. Do nonspecific deep corticomedullary sutures performed during partial nephrectomy adequately control major vascular and collecting system injury? BJU Int 2010; 105:411-5. [DOI: 10.1111/j.1464-410x.2009.08710.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Choe CH, L'Esperance JO, Auge BK. The use of adjunctive hemostatic agents for tubeless percutaneous nephrolithotomy. J Endourol 2009; 23:1733-8. [PMID: 19785556 DOI: 10.1089/end.2009.1543] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Tubeless percutaneous nephrolithotomy (PCNL) is a viable option for selected patients, particularly those with solitary calculi, multiple stones located in a single location, or those that can be accessed using one access tract. Benefits over the standard PCNL include reduced hospital stay, decreased pain, and decreased urine leak from the access site that would typically occur from around the nephrostomy tube. Hemostatic agents in the form of fibrin "glue" or gelatin matrix substances have been demonstrated to be safe and effective to augment the tubeless procedure. The most appropriate sealant agent available is yet to be determined. We present a review of the contemporary literature on the use of hemostatic agents for tubeless PCNL.
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Affiliation(s)
- Chong H Choe
- Department of Urology, Naval Medical Center, San Diego, CA, USA
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Nasso G, Piancone F, Bonifazi R, Romano V, Visicchio G, De Filippo CM, Impiombato B, Fiore F, Bartolomucci F, Alessandrini F, Speziale G. Prospective, Randomized Clinical Trial of the FloSeal Matrix Sealant in Cardiac Surgery. Ann Thorac Surg 2009; 88:1520-6. [DOI: 10.1016/j.athoracsur.2009.07.014] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2009] [Revised: 07/06/2009] [Accepted: 07/10/2009] [Indexed: 11/24/2022]
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Topical Haemostatics in Renal Trauma—An Evaluation of Four Different Substances in an Experimental Setting. ACTA ACUST UNITED AC 2009; 66:602-11. [DOI: 10.1097/ta.0b013e3181823533] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rouach Y, Delongchamps NB, Patey N, Fontaine E, Timsit MO, Thiounn N, Méjean A. Suture or Hemostatic Agent During Laparoscopic Partial Nephrectomy? A Randomized Study Using a Hypertensive Porcine Model. Urology 2009; 73:172-7. [DOI: 10.1016/j.urology.2008.08.477] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 08/11/2008] [Accepted: 08/13/2008] [Indexed: 10/21/2022]
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Dalpiaz O, Neururer R, Bartsch G, Peschel R. Haemostatic sealants in nephron-sparing surgery: what surgeons need to know. BJU Int 2008; 102:1502-8. [DOI: 10.1111/j.1464-410x.2008.08035.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pryor SG, Sykes J, Tollefson TT. Efficacy of Fibrin Sealant (Human) (Evicel) in Rhinoplasty. ACTA ACUST UNITED AC 2008; 10:339-44. [DOI: 10.1001/archfaci.10.5.339] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Shepherd G. Pryor
- Department of Otolaryngology–Head and Neck Surgery, University of California, Davis Medical Center, Sacramento (Drs Sykes and Tollefson). Dr Pryor is in private practice in Scottsdale, Arizona
| | - Jonathan Sykes
- Department of Otolaryngology–Head and Neck Surgery, University of California, Davis Medical Center, Sacramento (Drs Sykes and Tollefson). Dr Pryor is in private practice in Scottsdale, Arizona
| | - Travis T. Tollefson
- Department of Otolaryngology–Head and Neck Surgery, University of California, Davis Medical Center, Sacramento (Drs Sykes and Tollefson). Dr Pryor is in private practice in Scottsdale, Arizona
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[Preventing urinary fistulas in laparoscopic renal conservative parenchyma surgery with purified bovine serum albumin and glutaraldehyde (bioglue). Initial outcomes]. Actas Urol Esp 2008; 32:316-9. [PMID: 18512388 DOI: 10.1016/s0210-4806(08)73836-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Urinary fistulas remain an important conservative renal parenchyma surgery (CRPS) complication, especially in central or hiliar tumours and bigger than 4 cm. Herein we present our initial experience preventing fistulae with bioglue (Criolife Inc GA, USA) on laparoscopic CRPS in which urinary tract was opened. PATIENTS AND METHODS We performed 5 laparoscopic CRPS between September 2005 and February 2006 in which urinary tract was necessarily opened. Previous uretheral catheter, transperitoneal approach, selective arterial control, tumorectomy or heminephrectomy, suturing urinary tract and renal parenchyma and bioglue administration was performed. RESULTS Median follow up time was 8.2 months (6-12 months). Median surgery time was 138 minutes (105-180 minutes) with a median ischemia time of 45 minutes (35-60). Uretheral catheter was removed before second post-op day in all cases. Average discharged day was 3.8 (3-5 days). One patient required intraoperative transfusion due to breaking Rummel tourniquet and one arterio- calyceal fistula on tenth day pos-op that required selective embolization remained the worst complication. Neither urinary fistulas nor urinomas were reported. CONCLUSIONS Uretheral cathetesim, suturing urinary tract and parenchyma in an independent fashion and applying some kind of surgical adhesive such as bioglue seems to reduce the urinary fistulae risk in laparoscopic CRPS.
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Gelatin Thrombin Granules for Hemostasis in a Severe Traumatic Liver and Spleen Rupture Model in Swine. ACTA ACUST UNITED AC 2008; 64:456-61. [DOI: 10.1097/ta.0b013e3180340de1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Zorn KC, Gong EM, Orvieto MA, Gofrit ON, Mikhail AA, Shalhav AL. Impact of Collecting-System Repair during Laparoscopic Partial Nephrectomy. J Endourol 2007; 21:315-20. [PMID: 17444778 DOI: 10.1089/end.2006.0294] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Laparoscopic partial nephrectomy (LPN) is a complex procedure frequently reserved for small, peripherally located renal tumors. Deep, infiltrating lesions often necessitate collecting system repair (CSR), mandating further intracorporeal suturing and reconstruction. We compared our experience with LPN where CSR was and was not required after tumor resection. PATIENTS AND METHODS Between October 2002 and December 2005, 84 patients underwent LPN. Tumor excision with pelvicaliceal system injury occurred in 52 patients, whereas 32 patients required no CSR. Perioperative and pathologic data were compared in the two groups. RESULTS Tumors with CSR were larger (mean 2.9 cm v 2.1 cm for non-CSR procedures; P = 0.001) and had larger pathologic specimen weights (mean 58.2 g v 21.8 g; P = 0.05). Blood loss (mean 210 mL) and hospital stay (mean 2.7 days) were similar in the two groups. Warm ischemia time (WIT) (mean 36.6 v 27.7 minutes; P < 0.001) and operative time (mean 238 v 207 minutes; P = 0.03) were longer in the CSR group. The intraoperative hemorrhage rate (7.7% v 9.4%; P = 0.34) and rate of conversion to open surgery (7.7% v 9.4%; P = 0.29) were similar, as were the incidences of postoperative bleeding (7.7% v 3.1%; P = 0.28) and urinary leakage (1.9% v 0; P = 0.62). CONCLUSION Laparoscopic partial nephrectomy involving CSR is a technically demanding procedure that necessitates longer WIT and overall surgical time. However, when performed by an experienced laparoscopic surgeon, comparable complication rates and blood loss are observed. Technical variations for hemostasis, such as argon-beam coagulation and FloSeal and the use of the LapraTy clip for pelvicaliceal and parenchymal suture repair may facilitate LPN for more deeply invasive tumors.
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Affiliation(s)
- Kevin C Zorn
- Section of Urology, University of Chicago Pritzker School of Medicine, Chicago, Illinois 60637, USA.
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FISS I, DANNE M, STENDEL R. Use of Gelatin-Thrombin Matrix Hemostatic Sealant in Cranial Neurosurgery. Neurol Med Chir (Tokyo) 2007; 47:462-7. [DOI: 10.2176/nmc.47.462] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ingo FISS
- Department of Neurosurgery, Charité-University Medicine Berlin, Campus Benjamin Franklin
| | - Marco DANNE
- Department of Neurosurgery, Charité-University Medicine Berlin, Campus Benjamin Franklin
| | - Ruediger STENDEL
- Department of Neurosurgery, Charité-University Medicine Berlin, Campus Benjamin Franklin
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Shah HN, Hegde S, Shah JN, Mohile PD, Yuvaraja TB, Bansal MB. A Prospective, Randomized Trial Evaluating the Safety and Efficacy of Fibrin Sealant in Tubeless Percutaneous Nephrolithotomy. J Urol 2006; 176:2488-92; discussion 2492-3. [PMID: 17085137 DOI: 10.1016/j.juro.2006.07.148] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE We performed a prospective, randomized trial to assess the safety and efficacy of fibrin sealant in tubeless percutaneous nephrolithotomy. MATERIALS AND METHODS A total of 63 patients undergoing tubeless percutaneous nephrolithotomy were randomized to receive Tisseel vapor heated sealant at the end of the procedure. Fibrin sealant was instilled under direct vision in the nephrostomy tract at the end of the procedure. Patients younger than 14 years and those undergoing staged percutaneous nephrolithotomy or bilateral simultaneous percutaneous nephrolithotomy were excluded from study. Patients needing greater than 2 percutaneous tracts, those with significant bleeding or associated pyonephrosis and those with a residual stone burden were also excluded from study. The perioperative outcome in these patients (experimental group) was compared with the outcome in those undergoing tubeless percutaneous nephrolithotomy without fibrin sealant (control group). RESULTS Fibrin sealant was instilled in 32 patients. There was no difference in the hematocrit decrease and blood transfusion requirement in the 2 groups. Patients in the experimental group experienced less postoperative pain and required less analgesia. They were discharged home 5 hours earlier than patients in the control group. However, this difference was not statistically significant. Complete stone clearance was achieved in 87.5% of patients in the experimental group and in 90.32% of controls. CONCLUSIONS The instillation of Tisseel fibrin glue is safe for tubeless percutaneous nephrolithotomy. It is associated with less postoperative pain and a lower analgesic requirement. Additional prospective, randomized studies are required to better define its clinical role in the future.
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Affiliation(s)
- Hemendra N Shah
- R. G. Stone Urological Research Institute, Khar (W), and Tata Memorial Hospital, 21-A, 14-A Road, Ahimsa Marg, Mumbai 400052, India.
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Abstract
PURPOSE OF REVIEW To review the current techniques and technologies being used for hemostatic control during laparoscopic partial nephrectomy. RECENT FINDINGS Laparoscopic nephron-sparing surgery has become more common for the treatment of renal masses. With increasing experience, the indications for nephron sparing are increasing. Despite the increased use of these techniques in high-volume centers, however, more widespread application has been limited because of the need for advanced laparoscopic skills including the laparoscopic control of intraoperative renal bleeding. As a result, many techniques have been developed to achieve hemostasis, including conventional suture repair, tissue sealants, radiofrequency ablation, lasers, water dissection, and microwave tissue coagulation. SUMMARY Laparoscopic partial nephrectomy is a technically challenging procedure. Many promising techniques are being developed currently, most geared toward improved hemostasis and collecting system repair. These techniques and products have made, and will continue to make, the procedure less demanding and more universally accepted.
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Affiliation(s)
- Rustin Chanc Walters
- Urology Department, Naval Medical Center San Diego, San Diego, California 92134-7200, USA
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Bibliography. Current world literature. Bladder cancer. Curr Opin Urol 2006; 16:386-9. [PMID: 16905987 DOI: 10.1097/01.mou.0000240314.93453.d4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Peretti GM, Xu JW, Bonassar LJ, Kirchhoff CH, Yaremchuk MJ, Randolph MA. Review of Injectable Cartilage Engineering Using Fibrin Gel in Mice and Swine Models. ACTA ACUST UNITED AC 2006; 12:1151-68. [PMID: 16771631 DOI: 10.1089/ten.2006.12.1151] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
More than a decade of work has been devoted to engineering cartilage for articular surface repair. This review covers the use of fibrin gel polymer as an injectable scaffold for generating new cartilage matrix from isolated articular chondrocytes beginning with studies in mice and culminating in an applied study in swine joints. These studies began with developing a formulation of fibrin that was injectable and promoted cartilage matrix formation. Subsequent studies addressed the problems of volume loss after the scaffolds were placed in vivo by adding lyophilized cartilage matrix. Additional studies focused on the ability of isolated chondrocytes to heal and repair cartilage in a model that could be biomechanically tested. In conclusion, this series of studies demonstrated that fibrin gel is a suitable polymer gel for generating new cartilage matrix from articular chondrocytes. The new matrix is capable of forming mechanical bonds between cartilage disks and can lead to healing and integration. Armed with these results, implantation of fibrin-cell constructs into defects in swine knees showed new cartilage formation and filling of the defects. Continuing work in these models with fibrin and other polymerizable hydrogels could result in a suitable cell-based therapy for articular cartilage lesions.
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