Laparoscopic heminephrectomy using a new fibrin sealant powder.
OBJECTIVE
To determine the ability of a hemostatic fibrin sealant powder (HFSP), delivered laparoscopically, to achieve hemostasis and seal the collecting system during laparoscopic heminephrectomy.


METHODS
An HFSP preparation was applied laparoscopically as a dry powder spray. Twenty-two farm pigs were randomized into two laparoscopic heminephrectomy groups: group 1 underwent conventional intracorporal suturing with vascular control (n = 11) and group 2 received HFSP application alone with regional ischemia (n = 11). Computed tomography was performed at 48 hours and again 6 weeks postoperatively.


RESULTS
The operative findings revealed no differences between the two groups in the weight of the removed segments, mean arterial blood pressure, operating room time, estimated blood loss, or hematocrit and serum creatinine levels. The gross examination 6 weeks postoperatively found no delayed bleeding, urinoma formation, or bowel adhesions. The computed tomography findings at 48 hours postoperatively demonstrated excellent hemostasis in both groups. Urinary extravasation was detected in 8 (80%) of 10 animals in the HFSP group and 1 (9%) of 11 in the conventional group at 48 hours (P < 0.008). At the 6-week computed tomography evaluation, none of the animals showed evidence of urinoma or hematoma formation. Histopathologically, at 6 weeks, the cut surface of the kidneys in both groups had been replaced by dense scar tissue at the cortex with a sharp line of demarcation between the scar and normal kidney.


CONCLUSIONS
HFSP greatly facilitates laparoscopic heminephrectomy by providing rapid and lasting hemostasis without suturing. Early urine extravasation was more common in the HFSP group, but no clinical, gross, or radiographic evidence of urinoma formation was seen in either group 6 weeks after surgery.
Bishoff
Jay T
JT
Urology Service and Department of Radiology, Wilford Hall Medical Center, Lackland Air Force Base, Texas 78253, USA.
Cornum
Rhonda L
RL
Perahia
Barak
B
Seay
Thomas
T
Eliason
Stephen
S
Katus
Mathew
M
Morey
Alan
A
Gresham
Vincent
V
Pusateri
Anthony
A
Murcin
Lara A
LA
Tuthill
David
D
Friedman
Stanley
S
D000818:Animals; D015718:Fibrin Tissue Adhesive / Q000008:administration & dosage*; D016558:Hemostasis, Endoscopic / Q000379:methods*; D006490:Hemostatics / Q000008:administration & dosage*; D006801:Humans; D007511:Ischemia; D007685:Kidney Tubules, Collecting / Q000601:surgery; D010535:Laparoscopy / Q000379:methods*; D009392:Nephrectomy / Q000379:methods*; D011208:Powders; D011897:Random Allocation; D013536:Suture Techniques; D013552:Swine; D014014:Tissue Adhesives / Q000008:administration & dosage*; D014556:Urine
D015718:Fibrin Tissue Adhesive; D006490:Hemostatics; D011208:Powders; D014014:Tissue Adhesives