Does the absorbable fibrin adhesive bandage facilitate partial nephrectomy?
OBJECTIVE
To evaluate the ability of the absorbable fibrin adhesive bandage (AFAB), a prototype product comprising lyophilized fibrinogen and thrombin on a VicrylTM mesh backing, to seal the collecting system and control bleeding after partial nephrectomy.


METHODS
Growing female pigs (n = 18) underwent left nephrectomy and a 40% (by length) right lower pole partial nephrectomy. One of three treatments was immediately applied: Conventional-closure of the collecting system, ligation of visible segmental vessels, application of SurgicelTM with bolstering sutures to the renal capsule; AFAB-application of up to two 4 x 4-inch AFABs held under pressure for 60 seconds; Placebo-application of a hemostatically inert VicrylTM bandage, visually identical to the AFAB. Blood loss and ischemic and total operative times were recorded, and abdominal computerized tomography (CT) was performed on postoperative day 6. Animals were sacrificed at 6 weeks to evaluate the remaining renal mass histologically.


RESULTS
Compared with conventional therapy, use of the AFAB resulted in significantly less bleeding (13 versus 68 ml., p <0.001) and lower operative (7.2 versus 16.3 minutes, p <0.001) and ischemic times (3.4 versus 7.8 minutes, p <0.001). Estimated blood loss in the placebo bandage group was dramatically higher (357 ml., p <0.001). Postoperative CT and histological sectioning suggested that the AFAB produces a stable, durable clot and that healing is at least as successful as with conventional treatment.


CONCLUSIONS
Use of the AFAB facilitated performance of partial nephrectomy by reducing blood loss and ischemic and total operative times. The AFAB appears equivalent to conventional surgery in its ability to seal the collecting system.
Cornum
R L
RL
Urology Service and Departments of Pathology and Radiology, Brooke Army Medical Center and Institute of Surgical Research, Fort Sam Houston, TX, USA.
Morey
A F
AF
Harris
R
R
Gresham
V
V
Daniels
R
R
Knight
R W
RW
Beall
D
D
Pusateri
A
A
Holcomb
J
J
Macphee
M
M
D020341:Absorbable Implants; D000818:Animals; D001458:Bandages; D001777:Blood Coagulation / Q000187:drug effects; D016063:Blood Loss, Surgical; D002483:Cellulose, Oxidized / Q000627:therapeutic use; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000008:administration & dosage / Q000627:therapeutic use*; D005340:Fibrinogen / Q000008:administration & dosage / Q000627:therapeutic use; D006490:Hemostatics / Q000008:administration & dosage / Q000627:therapeutic use*; D007511:Ischemia / Q000209:etiology; D007668:Kidney / Q000098:blood supply / Q000000981:diagnostic imaging; D007685:Kidney Tubules, Collecting / Q000601:surgery; D008026:Ligation; D009392:Nephrectomy / Q000379:methods*; D010919:Placebos; D011098:Polyglactin 910; D013526:Surgical Mesh; D013536:Suture Techniques; D013552:Swine; D013917:Thrombin / Q000008:administration & dosage / Q000627:therapeutic use; D013997:Time Factors; D014014:Tissue Adhesives / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D014945:Wound Healing
D002483:Cellulose, Oxidized; D015718:Fibrin Tissue Adhesive; D006490:Hemostatics; D010919:Placebos; D014014:Tissue Adhesives; D011098:Polyglactin 910; C013695:Surgicel; D005340:Fibrinogen; D013917:Thrombin