Controlled survival study of the effects of Tisseel or a combination of FloSeal and Tisseel on major vascular injury and major collecting-system injury during partial nephrectomy in a porcine model.
OBJECTIVE
We report the results of a controlled survival study in a porcine model investigating Tisseel or a combination of FloSeal and Tisseel in dealing with vascular and collecting-system injury during partial nephrectomy.


METHODS
We performed an open right lower-pole partial nephrectomy on 15 large female pigs. The defect was repaired using standard open techniques (N = 5; controls), Tisseel only (N = 6; group I), or FloSeal followed by Tisseel (N = 4; group II). A Jackson-Pratt drain was placed. Nephrectomy and retrograde pyelography were performed at 1 week.


RESULTS
Operative times were shorter in both study groups, achieving statistical significance in group I (P = 0.008). Warm-ischemia times were significantly improved in both study groups (P = 0.029 and P = 0.00005 in groups I and II, respectively). Time to hemostasis was significantly shorter in group II only (P = 0.002) but approached significance in Group I as well (P = 0.09). Estimated blood loss was not significantly different from the controls in either group. When Tisseel was placed alone after hilar control, hematoma formation under the Tisseel was noted on release of the hilar clamp. After 1 week, there was one urinoma and three urine leaks in the control group. In group I, there was one urinoma and four urine leaks, and there was only one urine leak and no urinomas in group II. There were no hematomas in any of the groups.


CONCLUSIONS
Tisseel alone is not adequate for either hemostasis or management of major collecting-system injury. FloSeal capped with Tisseel appears sufficient to control major vascular and collecting-system injuries without adjunctive surgical measures. A proposed technique for laparoscopic partial nephrectomy without reconstructive techniques is presented that warrants clinical study.
L'Esperance
James O
JO
Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
Sung
Jeffrey C
JC
Marguet
Charles G
CG
Maloney
Michaella E
ME
Springhart
W Patrick
WP
Preminger
Glenn M
GM
Albala
David M
DM
D000818:Animals; D005260:Female; D015718:Fibrin Tissue Adhesive; D005781:Gelatin Sponge, Absorbable; D006490:Hemostatics; D015601:Injury Severity Score; D007431:Intraoperative Complications / Q000401:mortality* / Q000628:therapy*; D007685:Kidney Tubules, Collecting / Q000293:injuries*; D023421:Models, Animal; D009392:Nephrectomy / Q000379:methods*; D015996:Survival Rate; D013552:Swine; D014014:Tissue Adhesives
D015718:Fibrin Tissue Adhesive; C411004:FloSeal Matrix; D006490:Hemostatics; D014014:Tissue Adhesives