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Application of Hemostatic Devices in Laparoscopic Hepatectomy
Published on: April 19, 2022
Hemostatic agents and instruments in laparoscopic renal surgery.
Lambda P Msezane1, Mark H Katz, Ofer N Gofrit
1Section of Urology, Department of Surgery, University of Chicago Medical Center, Pritzker School of Medicine, Chicago, Illinois, USA. kevinzorn@hotmail.com
Journal of Endourology
|March 22, 2008
Summary
Controlling bleeding during laparoscopic partial nephrectomy is challenging. Combining suturing with hemostatic agents and energy devices offers effective bleeding control, especially for patients with impaired kidney function.
Area of Science:
- Urology
- Surgical Technology
- Nephrology
Background:
- Hemostasis during laparoscopic renal surgery, particularly partial nephrectomy, presents significant technical challenges.
- While sutured renorrhaphy is effective, it requires considerable skill to minimize warm ischemia time.
- The expanding array of hemostatic options necessitates a review of current techniques and technologies.
Purpose of the Study:
- To review and categorize the various methods and technologies used for hemostasis in laparoscopic renal surgery.
- To discuss the advantages, limitations, and potential complications associated with different hemostatic approaches.
- To highlight the trend towards multimodal strategies in achieving effective bleeding control.
Main Methods:
- Review of literature on hemostatic techniques in laparoscopic partial nephrectomy.
- Categorization of hemostatic methods into mechanical (sutures, sealants), chemical (tissue adhesives), and energy-based devices.
- Discussion of specific agents including fibrin sealants, collagen-based adhesives, hydrogels, oxidized cellulose, monopolar/bipolar cautery, argon beam coagulator, lasers, and radiofrequency devices.
Main Results:
- Sutured renorrhaphy remains a cornerstone but demands high surgical skill.
- Tissue sealants and adhesives (fibrin, collagen, hydrogel, glutaraldehyde-based) offer barrier function and hemostasis.
- Energy-based technologies (cautery, argon beam, lasers, radiofrequency) provide diverse methods for tissue coagulation and sealing, each with specific benefits and risks.
- Multimodality approaches, combining sutures with sealants or energy devices, are frequently employed for optimal hemostasis, particularly in complex cases or compromised renal function.
Conclusions:
- Achieving effective hemostasis in laparoscopic partial nephrectomy requires careful selection and often combination of techniques.
- Tissue sealants, adhesives, and various energy-based devices augment traditional suturing methods.
- Multimodal strategies are often necessary to manage bleeding effectively, balancing efficacy with potential complications and cost considerations.
