Sprayed Fibrin Sealant as the Sole Hemostatic Agent for Porcine Laparoscopic Partial Nephrectomy

Abstract

No AccessJournal of UrologyInvestigative Urology1 Jan 2011Sprayed Fibrin Sealant as the Sole Hemostatic Agent for Porcine Laparoscopic Partial Nephrectomy Donald Lowell Pick, Surendra B. Kolla, Phillip Mucksavage, Michael K. Louie, Petros Sountoulides, Oskar Kaufmann, Stephania Olamendi, Adam Kaplan, Victor Huynh, Cervando Ortiz-Vanderdys, Hung P. Truong, Shary A. Said, Lorena Andrade, Jane Tongson-Ignacio, Elspeth M. McDougall, and Ralph V. Clayman Donald Lowell PickDonald Lowell Pick , Surendra B. KollaSurendra B. Kolla , Phillip MucksavagePhillip Mucksavage , Michael K. LouieMichael K. Louie , Petros SountoulidesPetros Sountoulides , Oskar KaufmannOskar Kaufmann , Stephania OlamendiStephania Olamendi , Adam KaplanAdam Kaplan , Victor HuynhVictor Huynh , Cervando Ortiz-VanderdysCervando Ortiz-Vanderdys , Hung P. TruongHung P. Truong , Shary A. SaidShary A. Said , Lorena AndradeLorena Andrade , Jane Tongson-IgnacioJane Tongson-Ignacio , Elspeth M. McDougallElspeth M. McDougall , and Ralph V. ClaymanRalph V. Clayman View All Author Informationhttps://doi.org/10.1016/j.juro.2010.09.002AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Tisseel® is used to control minor bleeding during laparoscopic procedures. The DuploSpray MIS™ spray system allows thin, even application over a larger surface area. We use sprayed Tisseel as the sole agent to control hemorrhage and seal the renal collecting system after severe porcine laparoscopic partial nephrectomy. Methods and Materials: We performed staged bilateral severe laparoscopic partial nephrectomy in 12 Yucatan pigs using a longitudinal cut from upper to lower pole through the entire collecting system. In each pig 1 kidney was harvested immediately while the other was harvested after 4 weeks. After hilar clamping laparoscopic partial nephrectomy was done with cold scissors in 6 pigs while LigaSure™ was used in the other 6. Sprayed Tisseel was applied, and bleeding and urinary leakage were evaluated. Additional Tisseel was applied for repeat bleeding. We performed retrograde pyelogram (chronic) and burst pressure testing of the arterial and collecting systems. Results: All animals survived 4 weeks. One urinoma was seen on retrograde pyelogram in the cold cut group. Average hilar clamp time was similar in the acute and chronic study arms. Average estimated blood loss was significantly less in the LigaSure group (p = 0.0045). Average arterial burst pressure was significantly different in the chronic and acute groups (605.8 vs 350.4 mm Hg, p = 0.008) but average collecting system burst pressure was similar (186.3 and 149.5 mm Hg, respectively). Conclusions: Sprayed Tisseel without suturing effectively sealed the arterial and collecting system after severe laparoscopic partial nephrectomy in the porcine model. References 1 : Laparoscopic radical partial nephrectomy of a renal tumour: initial case report. Min Invas Ther Allied Technol1997; 6: 252. Google Scholar 2 : Renal cell carcinoma guideline. Eur Urol2007; 51: 1502. Google Scholar 3 : Partial nephrectomy versus radical nephrectomy in patients with small renal tumors—is there a difference in mortality and cardiovascular outcomes?. J Urol2009; 181: 55. Link, Google Scholar 4 : Diffusion of surgical innovation among patients with kidney cancer. Cancer2008; 112: 1708. Google Scholar 5 : Patterns of care in adults with renal cell carcinoma: findings in a population based sample. J Urol2009; 181: 2462. Link, Google Scholar 6 : Safety and efficacy of currently available fibrin tissue adhesives. Am J Otolaryngol2001; 22: 230. Google Scholar 7 : Advantages of fibrin glue spray in laparoscopic liver biopsies. Surg Laparosc Endosc Percutan Tech2007; 17: 545. Google Scholar 8 : The impact of warm ischaemia on renal function after laparoscopic partial nephrectomy. BJU Int2005; 95: 377. Google Scholar 9 : The effects of ureteral mobilization and transection