title: Biological glues and collagen fleece for hemostasis during laparoscopic partial nephrectomy: technique and results of prospective study.
abstract: OBJECTIVE
  The aim of this prospective study was to evaluate the advantages or disadvantages of the use of fibrin glue and collagen fleece during laparoscopic partial nephrectomy.
  
  
  METHODS
  Two groups of patients were studied. Group A (n = 24) received parenchymal suture, whereas Group B (n = 20) received parenchymal suture with fibrin glue and collagen fleece. The two groups were similar in baseline characteristics. We evaluated patient age, size of the lesion at CT, operative time, ischemia time, and sealant technique in relation to blood loss, hospital stay, and hemorrhagic complications.
  
  
  RESULTS
  No significant difference was observed in perioperative parameters (P > 0.05). The mean size of lesion was 3.3 +/- 1.2 (range 1-8 cm) for group A and 3.0 +/- 1.3 (range 2-5 cm) for Group B. The mean operative time was 116 +/- 26.6 minutes (range 90-220 minutes) for group A and 130 +/- 23.5 minutes (range 90-210 minutes) for group B. The mean warm ischemia time was 28.8 +/- 5.7 minutes (range 18-60) minutes) and 35.6 +/- 6.2 minutes (range 20-52 minutes), respectively. The mean blood loss was 178 +/- 34.5 mL (range 50-400 ml) for group A and 219 +/- 44.6 mL (range 80-750 ml) for group B. The mean hospital stay was 5.9 +/- 1.2 days (range 5-8 days) for group A and 6.3 +/- 2.1 days (range 5-9 days) for group B. Four and two postoperative hemorrhage complications were observed in groups A and B, respectively.
  
  
  CONCLUSIONS
  The use of fibrin glues and collagen fleece should be considered an adjuvant, as it does not present any substantial advantages, the suture being the key point in hemostasis control. We believe that in order to improve hemostasis, the efficacy of other types of sealants should be studied, as we were not convinced by those we used.
authors: Department of Urology, University of Turin, San Luigi Hospital, Orbassano (TO), Italy.
authors: Francesco
authors: F
authors: Porpiglia
authors: Julien
authors: J
authors: Renard
authors: Michele
authors: M
authors: Billia
authors: Ivano
authors: I
authors: Morra
authors: Carlo
authors: C
authors: Terrone
authors: Roberto Mario
authors: RM
authors: Scarpa
mesh_terms: D000328:Adult; D000368:Aged; D003094:Collagen / Q000494:pharmacology*; D015718:Fibrin Tissue Adhesive / Q000494:pharmacology*; D006470:Hemorrhage; D006487:Hemostasis / Q000187:drug effects*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D019990:Perioperative Care; D011183:Postoperative Complications; D011446:Prospective Studies; D013537:Sutures
chemical_list: D015718:Fibrin Tissue Adhesive; D003094:Collagen