Randomized, Prospective Evaluation of Hemostatic Agents in Robotic-Assisted Laparoscopic Partial Nephrectomy

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Hemostatic agents (HAs) are commonly used in robotic-assisted laparoscopic partial nephrectomy (RALPN) to control bleeding.
• Evidence supporting the routine use of HAs in RALPN is limited.

Purpose of the Study:

• To evaluate the effectiveness of hemostatic agents in reducing perioperative blood loss during RALPN.
• To compare hemoglobin changes and major bleeding complications in patients undergoing RALPN with or without HAs.

Main Methods:

• A prospective, randomized controlled trial was conducted.
• Patients undergoing RALPN were randomized into two groups: one receiving HAs (HA+) and one not (HA-).
• Primary endpoint was the change in hemoglobin from baseline to postoperative day 1; secondary outcomes included major bleeding complications.

Main Results:

• 178 patients were analyzed (88 HA-, 90 HA+).
• No significant difference was observed in mean hemoglobin decrease between the HA- (1.7 g/dL) and HA+ (1.8 g/dL) groups (P = .5).
• Major bleeding complications occurred in 4.5% of the HA- group and 6.7% of the HA+ group (P = .7).

Conclusions:

• Routine use of hemostatic agents during RALPN does not appear to reduce perioperative blood loss.
• Hemostatic agents did not significantly lower the risk of major bleeding complications in this patient cohort.