Sutureless nephron-sparing surgery: use of albumin glutaraldehyde tissue adhesive (BioGlue).
OBJECTIVE
To determine the feasibility of using serum albumin glutaraldehyde tissue adhesive (BioGlue) to achieve hemostasis and prevent urine leakage during nephron-sparing surgery (NSS).


METHODS
From February 1993 to April 2005, 174 NSS operations were performed for renal cell carcinoma at our institute. A total of 143 patients underwent NSS with the traditional suturing technique (suture group) and 31 patients underwent a sutureless BioGlue sealing-only procedure (BioGlue group). We compared the two groups for clinical and tumor characteristics and surgical outcome.


RESULTS
The patient and tumor characteristics were similar in both groups. The average maximal tumor diameter was 4.21 cm (range 2.2 to 7) for the suture group and 3.67 cm (range 2 to 6.8) for the BioGlue group. The use of BioGlue reduced the mean warm ischemic time by 8.8 minutes (17.2 versus 26 minutes, P = 0.002). The mean estimated blood loss was 45.1 mL in the BioGlue group and 111.7 mL in the suture group (P = 0.001). Blood transfusion was required in 1 patient (3.2%) of the BioGlue group and 24 (17%) in the suture group (P = 0.014). None of the patients treated with BioGlue developed urinary fistula compared with three (2%) in the suture group.


CONCLUSIONS
Albumin glutaraldehyde tissue adhesive (BioGlue) alone provided adequate hemostasis during NSS, significantly decreasing the blood loss and transfusion rate, as well as the renal ischemic and operative times. BioGlue was easy to use and safe for sealing the kidney during partial nephrectomy. Future prospective clinical trials are necessary to validate its role during renal surgery.
Hidas
G
G
Department of Urology, Bnai-Zion and Medical Center, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. guy@hidas.net
Kastin
A
A
Mullerad
M
M
Shental
J
J
Moskovitz
B
B
Nativ
O
O
D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons; D011506:Proteins; D013536:Suture Techniques; D014014:Tissue Adhesives
C472676:Bio-glue; D011506:Proteins; D014014:Tissue Adhesives