The Safety and Efficacy of Adjuvant Hemostatic Agents During Laparoscopic Nephron-Sparing Surgery: Comparison of Tachosil and Floseal Versus No Hemostatic Agents
Urology Journal,
Vol. 15 No. 1 (2018),
23 January 2018
,
Page 21-25
https://doi.org/10.22037/uj.v15i1.4090
Abstract
Purpose: To compare the effectiveness of TachoSil and Floseal during laparoscopic nephron-sparing surgery (LNSS), and to evaluate postoperative complications, especially hemorrhage and urinary leakage.Materials and Methods: The medical records of all patients that underwent LNSS for a small renal mass (SRM) performed by the same experienced surgeon were retrospectively analyzed. The patients were divided into the following 3 groups, based on hemostatic agent: group 1: no adjuvant hemostatic agent (no AHA); group 2: TachoSil; group 3: Floseal.
Results: The study included 79 patients; no AHA group: n = 18; TachoSil group: n = 25; Floseal group: n = 36. The 3 groups were similar in terms of diameter [29.6 ± 11.5 mm, 26.4 ± 13.4 mm and 30.4 ± 9.6 mm, respectively (P = .218)] and PADUA scores [6.9 ± 0.9, 6.7 ± 1 and 6.9 ± 0.9, respectively (P =.540)]. Mean duration of surgery was significantly shorter in the Floseal group (120.9 ± 23.1 minutes) than in the no AHA group (156.6 ± 34.4 minutes). Mean ischemia time was longest in the no AHA group (24.3 ± 4 minutes) and shortest in the Floseal group
(21.3 ± 4.3 minutes). Intra-abdominal (IA) catheter drainage on postoperative day 1 was significantly higher in the no AHA group than
in the TachoSil and Floseal groups [156.9 ±78.3 mL vs. 72.6 ± 64.5 and 60.8 ± 30.2 mL, respectively (P < .05)]. Mean duration of hospitalization was 3.2 ± 0.5 days in the no AHA group that was significantly longer than in the Floseal group (2.8 ± 0.7 days) (P = .043). There were not any differences in intraoperative complications, the transfusion rate, surgical margin positivity, or postoperative complications between the 3 groups (P = .596, P =.403, P = 1.0, P = .876, respectively). However, pseudoaneurism as a late term complication occurred in 27.7% patients in the no AHA group.
Conclusion: TachoSil and Floseal are safe and effective adjuvant treatments for patients undergoing LNSS. They might be useful especially in preventing pseudo aneurisms, shortening intraoperative ischemia time and hospital stay and decreasing postoperative drainage. Shortened operation and warm ischemia time may also be attributed to long learning curve of LNSS.
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References
Haber GP, Gill IS. Laparoscopic partial nephrectomy: contemporary technique and outcomes. Eur Urol 2006;49:660-5.
Gill, I. S., Matin, S. F., Desai et al. Comparative analysis of laparoscopic versus open partial nephrectomy for renal tumors in 200 patients.
J Urol 2003;170:64-8.
Ramani, A. P., Desai, M. M., Steinberg, A. P. et al. Complications of laparoscopic partial nephrectomy in 200 cases. J Urol 2005;173:42-7.
Urlesberger H, Rauchenwald K, Henning K. Fibrin adhesives in surgery of the renal parenchyma. Eur Urol 1979;5:260-1.
Hidas G, Lupinsky L, Kastin A, Moskovitz B, Groshar D, Nativ O. Functional significance of using tissue adhesive substance in nephronsparing surgery: assessment by quantitative SPECT of 99m Tc-Dimercaptosuccinic acid scintigraphy. Eur Urol 2007;52:785-9.
Gill, I. S., Ramani, A. P., Spaliviero, M. et al. Improved hemostasis during laparoscopic partial nephrectomy using gelatin matrix thrombin sealant. Urology 2005;65:463-6.
Aron M, Gill IS. Minimally invasive nephronsparing surgery (MINSS) for renal tumours part I: laparoscopic partial nephrectomy. Eur Urol 2007;51:337-46; discussion 46-7.
Pruthi RS, Chun J, Richman M. The use of a fibrin tissue sealant during laparoscopic partial nephrectomy. BJU Int 2004;93:813-7.
Richter, F., Schnorr, D., Deger, S. et al. Improvement of hemostasis in open and laparoscopically performed partial nephrectomy using a gelatin matrix-thrombin tissue sealant (Floseal). Urology 2003;61:73-7.
Klingler CH, Remzi M, Marberger M, Janetschek G. Haemostasis in laparoscopy. Eur Urol 2006;50:948-56; discussion 56-7.
Toro A, Mannino M, Reale G, Di Carlo I. TachoSil use in abdominal surgery: a review. J Blood Med 2011;2:31-6.
Siemer, S., Lahme, S., Altziebler, S. et al. Efficacy and safety of TachoSil as haemostatic treatment versus standard suturing in kidney
tumour resection: a randomised prospective study. Eur Urol 2007;52:1156-63.
Echave M, Oyaguez I, Casado MA. Use of Floseal(R), a human gelatine-thrombin matrix sealant, in surgery: a systematic review. BMC
Surg 2014;14:111.
Breda, A., Stepanian, S. V., Lam, J. S. et al. Use of haemostatic agents and glues during laparoscopic partial nephrectomy: a multiinstitutional
survey from the United States and Europe of 1347 cases. Eur Urol 2007;52:798-803.
Matonick JP, Hammond J. Hemostatic efficacy of EVARREST, Fibrin Sealant Patch vs. TachoSil(R) in a heparinized swine spleen incision model. J Invest Surg 2014;27:360-5.
Mele E, Ceccanti S, Schiavetti A, Bosco S, Masselli G, Cozzi DA. The use of TachoSil as hemostatic sealant in nephron sparing surgery for Wilms tumor: preliminary observations. J Pediatr Surg 2013;48:689-94.
Fanari M, Serra S, Corona A, De Lisa A. [Use of TachoSil in laparoscopic enucleoresection of renal masses smaller than 4 cm: our preliminary experience of 41 cases]. Urologia 2012;79 Suppl 19:131-3.
Falsaperla, M., Autorino, R., Puglisi, M. et al. Haemostatic agents during laparoscopic nephron-sparing surgery: what about TachoSil? BJU Int 2009;104:270-1.
Colombo, G. L., Bettoni, D., Di Matteo, S. et al. Economic and outcomes consequences of TachoSil(R): a systematic review. Vasc Health Risk Manag 2014;10:569-75.
User HM, Nadler RB. Applications of Floseal in nephron-sparing surgery. Urology 2003;62:342-3.
Wille AH, Johannsen M, Miller K, Deger S. Laparoscopic partial nephrectomy using Floseal for hemostasis: technique and experiences in 102 patients. Surg Innov 2009;16:306-12.
Guzzo TJ, Pollock RA, Forney A, Aggarwal P, Matlaga BR, Allaf ME. Safety and efficacy of a surgeon-prepared gelatin hemostatic agent compared with Floseal for hemostasis in laparoscopic partial nephrectomy. J Endourol 2009;23:279-82.
Antonelli, A., Minervini, A., Mari, A. et al. TriMatch comparison of the efficacy of Floseal versus TachoSil versus no hemostatic agents for partial nephrectomy: results from a large multicenter dataset. Int J Urol 2015;22:47-52.
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