Haemostatics in surgery and our experience in the enucleoresection of renal cell carcinoma

Comparative Analysis of Electrosurgical Energy and Hemostatic Sealant for Hemostasis in Laparoscopic Ovarian Cystectomy: A Randomized Controlled Phase III Study

STUDY OBJECTIVE

To evaluate the efficacy of hemostatic sealant versus electrosurgical energy in achieving hemostasis and preserving postoperative ovarian reserve during laparoscopic ovarian cystectomy.

DESIGN

Randomized controlled trial.

SETTING

Single-center study.

PATIENTS

A total of 121 patients undergoing laparoscopic ovarian cystectomy.

INTERVENTIONS

Patients were randomized to receive either hemostatic sealant or electrosurgical energy for hemostasis during surgery.

MEASUREMENTS AND MAIN RESULTS

The primary outcome measured was the time required to achieve hemostasis. Secondary outcomes included operating time, estimated blood loss, and assessment of postoperative ovarian reserve through hormone levels (anti-Müllerian hormone [AMH], follicle-stimulating hormone [FSH], E2, inhibin) at three follow-up intervals. The results showed comparable hemostasis times between the two groups. Postoperative hormone levels indicated no significant differences in the impact on ovarian reserve between the groups, except in cases of bilateral ovarian cystectomy, where the hemostatic sealant group exhibited a lesser decline in AMH levels.

CONCLUSION

Both hemostatic sealant and electrosurgical energy showed equivalent effectiveness in achieving hemostasis during laparoscopic ovarian cystectomy, with comparable results in hemostasis time, blood loss, postoperative complications, and ovarian reserve preservation. However, in cases of bilateral ovarian cystectomy, the hemostatic sealant group exhibited a lesser decline in AMH levels, suggesting a potential advantage in preserving ovarian reserve in these specific cases.

[Local hemostatic agent - fluid active hemostatic matrix]

Uncontrolled surgical bleeding can have significant clinical and economic consequences including advanced medical expenses and impairment of the outcomes. Effective and safe local hemostatic agents based on a fluid active hemostatic matrix are reviewed in the article. The use of this agent is followed by reduced hospital-stay, number of redo interventions for bleeding, reduced time of surgery, intra- and postoperative complication rate and high economic efficiency.

Hemostatic Agents and Tissue Sealants: Potential Mimics of Abdominal Abnormalities

OBJECTIVE

Topical tissue sealants and hemostatic agents, seen on postoperative imaging in a variety of intraabdominal and pelvic locations, have the potential to be mistaken for abdominal abnormalities, especially if the radiologist is not aware of the patient's surgical history. The normal appearance of these agents may mimic abscesses, tumors, enlarged lymph nodes, or retained foreign bodies. Therefore, it is important to be familiar with their typical imaging appearances and to review the surgical records when needed to avoid misdiagnoses. The purpose of this article is to increase the radiologist's familiarity with various types of topical tissue sealants and hemostatic agents used during surgical and percutaneous procedures in the abdomen and pelvis along with their radiologic appearances.

CONCLUSION

Various types of hemostatic agents are now commonly used during surgery and percutaneous procedures in the abdomen and pelvis, and it is important to recognize the various appearances of these agents. Although there are suggestive features outlined in this article, the most important factor for the radiologist is to be aware of the patient's history and the possibility that a hemostatic agent may be present. On postoperative imaging, hemostatic agents may mimic abscesses, tumors, enlarged lymph nodes, or retained foreign bodies, and accurate diagnosis can save a patient unnecessary treatment. It is therefore crucial to incorporate knowledge of the patient's surgical history with recognition of the typical imaging appearances of hemostatic agents and other pseudolesions to avoid misdiagnoses.

Similar patient outcomes yet different hospital costs between flowable hemostatic agents

INTRODUCTION

SURGIFLO and FLOSEAL are absorbable gelatin-based products that form hemostatic matrices. These products are indicated as adjuncts to hemostasis when control of bleeding by conventional surgical techniques (such as suture, ligature or cautery) is ineffective or impractical. This study analyzed the effect of surgery time and the choice of product on cost to the hospital and patient outcomes.

METHODS

The data source was the Premier Hospital database from January 1, 2010-June 30, 2012. Eligible patients were ≥18 years of age with a spinal fusion or refusion surgery with either SURGIFLO (Ethicon Inc.) or FLOSEAL (Baxter International Inc.). The hospital Charge Master was used to identify the amount of flowable product, whether it included Thrombin, and the cost. Multivariable models were performed on overall cost and likelihood of surgical complications. All models were adjusted for patient demographics and severity as well as hospital, and surgical characteristics.

RESULTS

A total of 24,882 patient records from 121 hospitals were analysed, which included 15,088 FLOSEAL records and 9794 SURGIFLO records, with 1498 SURGIFLO with Thrombin patients. Little or no differences in surgical complications were found between surgeries with SURGIFLO vs. surgery with FLOSEAL. Regression models showed a reduction in cost of $65 associated with use of SURGIFLO with Thrombin and an additional $21 reduction in hospital cost for each additional hour of surgery. Modeling which accounts for hospital fixed effects suggest that, in addition to a gap of ∼$300 favoring SURGIFLO with Thrombin, every additional hour of surgery was associated with an additional reduction in hospital costs of ∼$26.

CONCLUSIONS

While the choice of flowable product had no effect on clinical outcomes, use of SURGIFLO was associated with hospital cost savings for flowable product. These savings increased with the length of surgery, even when controlling for the amount of flowable product (mL) used.

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

Background

Surgical 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.

Methods

An 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.

Results

A 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.

Conclusions

The majority of the selected studies confirmed that Floseal^® showed improvements over other haemostatic agents in achieving haemostasis and reducing blood loss.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2482-14-111) contains supplementary material, which is available to authorized users.