Autologous fibrin glue using the Vivostat system for hemostasis in laparoscopic partial nephrectomy.
OBJECTIVE
Haemostasis remains the greatest challenge during laparoscopic partial nephrectomy. Use of fibrin sealant currently is increasing. We describe first a technique for achieving effective haemostasis during laparoscopic partial nephrectomy using the Vivostat system.


METHODS
Ten patients underwent laparoscopic partial nephrectomy. Autologous fibrin sealant was prepared with the Vivostat system and applied to the resection bed. This system is an automated medical device for the preparation of an autologous fibrin sealant, generating up to 5 ml of sealant from 120 ml of the patient's blood. The concentration of fibrin and the volume of sealant are stable; the sealant may be kept at room temperature for up to 8 hours before application without a loss of properties and effectiveness. The patients were evaluated for acute and delayed bleeding.


RESULTS
Mean patient's age was 54 years (range, 31-68). Haemostasis was immediate in all cases after application of the sealant for 1 to 2 minutes to the resection site; no additional haemostatic measures were required. Mean warm ischemia time was 23 minutes (range, 20-27); mean blood loss was 90 cc (range, 20-200). Pre-operative and post-operative serum haemoglobin did not differ significantly (mean, 14.9 vs 12.6g/dl) and creatinine values (mean, 0.91 vs 0.95 ng/ml). Mean operative time was 136 minutes (range, 60-180). No postoperative bleeding or other complications occurred.


CONCLUSIONS
In this study, immediate haemostasis was achieved and maintained after the kidney was reperfused. Our initial experience with the Vivostat system in laparoscopic partial nephrectomy has been encouraging.
Schips
Luigi
L
Department of Urology, Medical University Graz, Austria. luigischips@hotmail.com
Dalpiaz
Orietta
O
Cestari
Andrea
A
Lipsky
Katja
K
Gidaro
Stefano
S
Zigeuner
Richard
R
Petritsch
Peter
P