Ultrasonographic appearance of Surgicel®: A systematic review

To perform a systematic review describing the most common ultrasonographic findings of the hemostatic agent Surgicel® and to identify different ultrasonographic patterns depending on ultrasound timing and localization of Surgicel®.

A systematic literature search was performed to identify studies reporting ultrasonographic findings of Surgicel® according to the PRISMA guidelines. We queried PubMed, Web of Science, and Scopus using the terms "Surgicel®" OR "oxidized regenerated cellulose" AND "Ultrasound" from inception to march 2024. Patients with Surgicel® application during surgeries and posterior description of ultrasound features were included in the study. Risk of bias was evaluated with a modified standardized tool. (PROSPERO ID CRD42024542619).

We found 464 articles, from which 12 articles were included, with a pooled population of 226 patients. Most rating as a moderate risk of bias. The predominant anatomical sites investigated were the breast and thyroid gland (94.68 %). The most frequent ultrasound appearance of Surgicel® was a hypo/isoechoic lesion with well-defined margins and internal hyperechoic nodules (49.11 %), followed by a hypo/isoechoic lesion with well-defined margins without internal hyperechoic nodules (18.58 %) and completely anechoic lesions (15.04 %). Hypo/isoechoic lesions with well-defined margins and internal hyperechoic nodules were frequent in the breast (55.56 %) and thyroid (53.49 %). Hyperechoic lesions with posterior reverberation artifact were consistently found in the liver, spleen, coronary vessels, and cervix (100 % each).

The most frequent ultrasound finding of Surgicel® was hypo/isoechoic lesions with well-defined margins and internal hyperechoic nodules. There may be distinct ultrasound characteristics of Surgicel® based on location. The impact of the type of organ, and timing of ultrasound remains to be defined.