Hand-assisted laparoscopic partial nephrectomy in the porcine model using gelatin matrix hemostatic sealant without hilar occlusion.
OBJECTIVE
Gelatin matrix hemostatic sealant (GMHS) has been used for hemostasis during partial nephrectomy with hilar clamping. The objective of this study was to determine the ability of GMHS to achieve hemostasis without hilar clamping in the porcine model.


METHODS
In this feasibility study, eight farm pigs underwent a left-hand-assisted laparoscopic partial nephrectomy (HALPN). The lower fourth of the kidney was removed with cold scissors, and GMHS was applied laparoscopically. Samples were collected for measurement of serum hemoglobin (Hb) and creatinine (Cr) prior to surgery and at 4 and 30 days after HALPN. The kidneys were harvested at 30 days, and retrograde pyelograms and pathologic analysis were performed.


RESULTS
Application of GMHS achieved complete hemostasis in all eight animals. The mean estimated blood loss was 40 mL, and the operating time was short (mean 92.5 minutes). In three kidneys, a significant collecting system opening was noted but not repaired. At harvest, there were no hematomas, infections, or urine leaks in any animals. In one animal, a 2-cm contained fluid collection was identified. There was no difference in the preoperative and harvest Hb (9.63 v 9.21 g/dL; P = 0.49), but there was a slight increase in Cr (1.21 v 1.46 mg/dL; P = 0.01) possibly because of the decreased renal mass after partial nephrectomy.


CONCLUSIONS
Even without hilar occlusion, GMHS was 100% safe and effective in controlling bleeding after HALPN in the porcine model. Avoidance of hilar occlusion may reduce the risk associated with warm renal ischemia and the extra dissection required to isolate the hilum in preparation for clamping.
Divisions of Urology, Loma Linda University School of Medicine, Loma Linda, California 92354, USA.
Premal J
PJ
Desai
Lincoln J
LJ
Maynes
Craig
C
Zuppan
Kenneth A
KA
Berger
Robert
R
Torrey
D Duane
DD
Baldwin
D000818:Animals; D005355:Fibrosis; D005780:Gelatin; D005781:Gelatin Sponge, Absorbable; D006489:Hemostatic Techniques; D006490:Hemostatics; D007668:Kidney / Q000098:blood supply / Q000473:pathology / Q000601:surgery; D020706:Laparoscopes; D023421:Models, Animal; D009392:Nephrectomy / Q000295:instrumentation* / Q000379:methods*; D034421:Sus scrofa; D014014:Tissue Adhesives
D006490:Hemostatics; D014014:Tissue Adhesives; D005780:Gelatin