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Laparoscopic heminephrectomy using a new fibrin sealant powder
Jay T Bishoff1, Rhonda L Cornum, Barak Perahia
1Urology Service and Department of Radiology, Wilford Hall Medical Center, Lackland Air Force Base, Texas 78253, USA.
Urology
|December 11, 2003
Summary
Hemostatic fibrin sealant powder (HFSP) provides rapid hemostasis for laparoscopic heminephrectomy. While early urine leakage occurred, HFSP demonstrated effective sealing and no long-term complications like urinoma formation.
Area of Science:
- Urology
- Surgical Innovation
- Biomaterials
Background:
- Laparoscopic heminephrectomy requires effective hemostasis and sealing of the collecting system.
- Conventional suturing can be time-consuming and technically challenging in laparoscopic procedures.
Purpose of the Study:
- To evaluate the efficacy of a hemostatic fibrin sealant powder (HFSP) for achieving hemostasis and sealing the collecting system during laparoscopic heminephrectomy.
- To compare HFSP application with conventional suturing techniques in a porcine model.
Main Methods:
- Twenty-two pigs underwent laparoscopic heminephrectomy, randomized to either conventional suturing (n=11) or HFSP application (n=11).
- HFSP was applied as a dry powder spray with regional ischemia.
- Postoperative computed tomography (CT) scans were performed at 48 hours and 6 weeks.
Main Results:
- No significant differences were observed in operative time, blood loss, or renal function between groups.
- Excellent hemostasis was achieved in both groups.
- Early urinary extravasation was higher in the HFSP group (80%) compared to the conventional group (9%) at 48 hours (P < 0.008).
- No urinomas or hematomas were detected at 6 weeks in either group.
- Histopathology at 6 weeks showed dense scar tissue formation at the surgical site in both groups.
Conclusions:
- HFSP facilitates laparoscopic heminephrectomy by providing rapid and durable hemostasis without the need for sutures.
- Despite increased early urine extravasation, HFSP did not lead to clinical, gross, or radiographic evidence of urinoma formation at 6 weeks post-surgery.