Systematic Review of Topical Hemostatic Agent Use in Minimally Invasive Gynecologic Surgery

Area of Science:

• Gynecologic Surgery
• Surgical Hemostasis
• Minimally Invasive Procedures

Background:

• Topical hemostatic agents (HA) are increasingly used in gynecologic procedures.
• Their effectiveness and impact on peri-operative outcomes in minimally invasive gynecologic surgery (MIGS) require systematic evaluation.

Purpose of the Study:

• To systematically review literature on the hemostatic effectiveness of topical HA.
• To evaluate peri-operative outcomes associated with HA use in MIGS for benign gynecologic conditions.

Main Methods:

• Systematic review of studies published up to March 31, 2017.
• Inclusion of comparative studies and case series (>10 participants) on topical HA in MIGS for benign conditions.
• Exclusion of studies on malignancy or open surgery; data isolation for MIGS was required.

Main Results:

• Eight studies were included, evaluating fibrin sealant and thrombin-gelatin matrix.
• Fibrin sealant decreased time to hemostasis, hemoglobin drop, and estimated blood loss (EBL) in laparoscopic myomectomy.
• Thrombin-gelatin matrix showed less decrease in anti-Mullerian hormone (AMH) levels on ovarian tissue compared to bipolar energy.

Conclusions:

• Topical HA application in MIGS can reduce operative time, blood loss, and preserve ovarian function.
• Further research is needed to establish evidence-based guidelines for HA use in various gynecologic procedures.
• High-quality evidence is required to guide the optimal application of hemostatic agents in MIGS.