title: Use of haemostatic agents and glues during laparoscopic partial nephrectomy: a multi-institutional survey from the United States and Europe of 1347 cases.
abstract: 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.
authors.affiliation: Department of Urology, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California, USA. abreda@mednet.ucla.edu
authors.forename: Alberto
authors.initials: A
authors.lastname: Breda
authors.forename: Sevan V
authors.initials: SV
authors.lastname: Stepanian
authors.forename: John S
authors.initials: JS
authors.lastname: Lam
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Liao
authors.forename: Inderbir S
authors.initials: IS
authors.lastname: Gill
authors.forename: Jose R
authors.initials: JR
authors.lastname: Colombo
authors.forename: Giorgio
authors.initials: G
authors.lastname: Guazzoni
authors.forename: Michael D
authors.initials: MD
authors.lastname: Stifelman
authors.forename: Kent T
authors.initials: KT
authors.lastname: Perry
authors.forename: Antonio
authors.initials: A
authors.lastname: Celia
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Breda
authors.forename: Paolo
authors.initials: P
authors.lastname: Fornara
authors.forename: Stephen V
authors.initials: SV
authors.lastname: Jackman
authors.forename: Antonio
authors.initials: A
authors.lastname: Rosales
authors.forename: Juan
authors.initials: J
authors.lastname: Palou
authors.forename: Michael
authors.initials: M
authors.lastname: Grasso
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pansadoro
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Disanto
authors.forename: Francesco
authors.initials: F
authors.lastname: Porpiglia
authors.forename: Claudio
authors.initials: C
authors.lastname: Milani
authors.forename: Claude C
authors.initials: CC
authors.lastname: Abbou
authors.forename: Richard
authors.initials: R
authors.lastname: Gaston
authors.forename: Gunter
authors.initials: G
authors.lastname: Janetschek
authors.forename: Naeem A
authors.initials: NA
authors.lastname: Soomro
authors.forename: Jean J
authors.initials: JJ
authors.lastname: De la Rosette
authors.forename: Pilar M
authors.initials: PM
authors.lastname: Laguna
authors.forename: Peter G
authors.initials: PG
authors.lastname: Schulam
mesh_terms: 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
chemical_list: D006490:Hemostatics; D014014:Tissue Adhesives