Use of haemostatic agents and glues during laparoscopic partial nephrectomy: a multi-institutional survey from the United States and Europe of 1347 cases.
OBJECTIVE
Laparoscopic partial nephrectomy (LPN) is a technically challenging procedure for the management of renal tumours. Major complications of LPN include bleeding and urine leakage. Haemostatic agents (HAs) and/or glues may reduce haemorrhage and urine leakage. We sought to examine the current practice patterns for urologists performing LPN with regard to HA use and its relationship with bleeding and urine leakage.


METHODS
A survey was sent via e-mail to urologists currently performing LPN in centres in the United States and Europe. We queried the indications for HA/glue usage, type of HAs/glues used, and whether concomitant suturing/bolstering was performed. In addition, the total number of LPNs performed, laparoscopic tools used to resect the tumour, tumour size, and tumour position were queried.


RESULTS
Surveys suitable for analysis were received from 18 centres (n=1347 cases). HAs and/or glues were used in 1042 (77.4%) cases. Mean tumour size was 2.8cm, with 79% of the tumours being defined as exophytic and 21% deep. The HAs and glues used included gelatin matrix thrombin (FloSeal), fibrin gel (Tisseel), bovine serum albumin (BioGlue), cyanoacrylate glue (Glubran), oxidized regenerated cellulose (Surgicel), or combinations of these. Sixteen centres performed concomitant suturing/bolstering. The overall postoperative bleeding requiring transfusion and urine leakage rates were 2.7% and 1.9%, respectively.


CONCLUSIONS
The use of HAs and/or glues is routine in most centres performing LPN. The overall haemorrhage and urine leakage rates are low following LPN. More studies are needed to assess the potential role of HAs and/or glues in LPN.
Breda
Alberto
A
Department of Urology, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California, USA. abreda@mednet.ucla.edu
Stepanian
Sevan V
SV
Lam
John S
JS
Liao
Joseph C
JC
Gill
Inderbir S
IS
Colombo
Jose R
JR
Guazzoni
Giorgio
G
Stifelman
Michael D
MD
Perry
Kent T
KT
Celia
Antonio
A
Breda
Guglielmo
G
Fornara
Paolo
P
Jackman
Stephen V
SV
Rosales
Antonio
A
Palou
Juan
J
Grasso
Michael
M
Pansadoro
Vincenzo
V
Disanto
Vincenzo
V
Porpiglia
Francesco
F
Milani
Claudio
C
Abbou
Claude C
CC
Gaston
Richard
R
Janetschek
Gunter
G
Soomro
Naeem A
NA
De la Rosette
Jean J
JJ
Laguna
Pilar M
PM
Schulam
Peter G
PG
D016063:Blood Loss, Surgical / Q000517:prevention & control*; D005060:Europe; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013536:Suture Techniques; D014014:Tissue Adhesives / Q000627:therapeutic use*; D014481:United States
D006490:Hemostatics; D014014:Tissue Adhesives