title: BioGlue iceball stabilization to minimize the risk of hemorrhage during laparoscopic renal cryoablation.
abstract: OBJECTIVE
  To evaluate the application of a BioGlue adhesive shell to minimize iceball fracture. Iceball fracture and hemorrhage is common with laparoscopic cryoablation (LCA) of larger (>4 cm) renal tumors.
  
  
  METHODS
  Twenty large iceballs were created in porcine kidneys using 3 cryoablation probes in a nonsurvival study. Each kidney underwent an upper and lower pole ablation. One pole in each kidney was covered with 5 mL of BioGlue and the opposite pole served as a control. A double freeze-thaw cycle was performed (10 minutes freeze and 5 minutes active thaw) in both renal poles simultaneously. The probes were removed and the sites were monitored for 20 minutes under direct vision. Fracture length (mm), severity of fracture depth, severity of bleeding (absent, mild, moderate, severe), and estimated blood loss (EBL) (mL) were recorded.
  
  
  RESULTS
  In the control group, the mean fracture length was 1.9 mm (range, 0-3 mm). Blood loss was absent in 10%, mild in 60%, and moderate in 30% of ablations. The mean EBL was 20.5 mL (range, 0-50 mL). For the BioGlue ablations, there were no parenchymal fractures. Blood loss was mild in 30% and absent in 70% of sites with an average EBL of 5 mL (range, 0-20). Two bleeding sites occurred as a result of subcapsular hematomas caused by initial probe placement.
  
  
  CONCLUSIONS
  BioGlue application minimized the frequency and magnitude of renal fracture. EBL was lower with BioGlue application and most sites demonstrated no postablation bleeding. Further clinical study of the BioGlue shell should be performed to confirm these results.
authors.affiliation: Department of Urology, University of California, Irvine, California, USA.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Mues
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Graversen
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Truesdale
authors.forename: Cristin
authors.initials: C
authors.lastname: Casazza
authors.forename: Jaime
authors.initials: J
authors.lastname: Landman
mesh_terms: D000818:Animals; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D003452:Cryosurgery / Q000379:methods*; D006488:Hemostasis, Surgical; D007053:Ice; D007680:Kidney Neoplasms / Q000601:surgery; D010535:Laparoscopy; D009392:Nephrectomy / Q000379:methods*; D010865:Pilot Projects; D011506:Proteins; D012307:Risk Factors; D013552:Swine
chemical_list: C472676:Bio-glue; D007053:Ice; D011506:Proteins