title: Sprayed fibrin sealant as the sole hemostatic agent for porcine laparoscopic partial nephrectomy.
abstract: OBJECTIVE
  Tisseel® is used to control minor bleeding during laparoscopic procedures. The DuploSpray MIS™ spray system allows thin, even application over a larger surface area. We use sprayed Tisseel as the sole agent to control hemorrhage and seal the renal collecting system after severe porcine laparoscopic partial nephrectomy.
  
  
  METHODS
  We performed staged bilateral severe laparoscopic partial nephrectomy in 12 Yucatan pigs using a longitudinal cut from upper to lower pole through the entire collecting system. In each pig 1 kidney was harvested immediately while the other was harvested after 4 weeks. After hilar clamping laparoscopic partial nephrectomy was done with cold scissors in 6 pigs while LigaSure™ was used in the other 6. Sprayed Tisseel was applied, and bleeding and urinary leakage were evaluated. Additional Tisseel was applied for repeat bleeding. We performed retrograde pyelogram (chronic) and burst pressure testing of the arterial and collecting systems.
  
  
  RESULTS
  All animals survived 4 weeks. One urinoma was seen on retrograde pyelogram in the cold cut group. Average hilar clamp time was similar in the acute and chronic study arms. Average estimated blood loss was significantly less in the LigaSure group (p = 0.0045). Average arterial burst pressure was significantly different in the chronic and acute groups (605.8 vs 350.4 mm Hg, p = 0.008) but average collecting system burst pressure was similar (186.3 and 149.5 mm Hg, respectively).
  
  
  CONCLUSIONS
  Sprayed Tisseel without suturing effectively sealed the arterial and collecting system after severe laparoscopic partial nephrectomy in the porcine model.
authors.affiliation: University of California-Irvine, Orange, California 92868, USA.
authors.forename: Donald Lowell
authors.initials: DL
authors.lastname: Pick
authors.forename: Surendra B
authors.initials: SB
authors.lastname: Kolla
authors.forename: Phillip
authors.initials: P
authors.lastname: Mucksavage
authors.forename: Michael K
authors.initials: MK
authors.lastname: Louie
authors.forename: Petros
authors.initials: P
authors.lastname: Sountoulides
authors.forename: Oskar
authors.initials: O
authors.lastname: Kaufmann
authors.forename: Stephania
authors.initials: S
authors.lastname: Olamendi
authors.forename: Adam
authors.initials: A
authors.lastname: Kaplan
authors.forename: Victor
authors.initials: V
authors.lastname: Huynh
authors.forename: Cervando
authors.initials: C
authors.lastname: Ortiz-Vanderdys
authors.forename: Hung P
authors.initials: HP
authors.lastname: Truong
authors.forename: Shary A
authors.initials: SA
authors.lastname: Said
authors.forename: Lorena
authors.initials: L
authors.lastname: Andrade
authors.forename: Jane
authors.initials: J
authors.lastname: Tongson-Ignacio
authors.forename: Elspeth M
authors.initials: EM
authors.lastname: McDougall
authors.forename: Ralph V
authors.initials: RV
authors.lastname: Clayman
mesh_terms: D000336:Aerosols; D000818:Animals; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000008:administration & dosage*; D006490:Hemostatics / Q000008:administration & dosage*; D010535:Laparoscopy; D009392:Nephrectomy / Q000379:methods*; D013552:Swine
chemical_list: D000336:Aerosols; D015718:Fibrin Tissue Adhesive; D006490:Hemostatics