The use of novel hemostatic sealant (Tisseel) in laparoscopic myomectomy: a case-control study.
BACKGROUND
This is the first case-control study on the use of a fibrin sealant (Tisseel) on uterine suture during laparoscopic myomectomy (LM), with the primary endpoint to evaluate the intraoperative bleeding and postoperative blood loss. In addition, we evaluated the time required to achieve hemostasis using Tisseel and how much it can influence operative time.


METHODS
From December 2009 to January 2011, consecutive patients older than 18 years with symptomatic isolate intramural myoma with maximal diameter B6 cm and ≥ 4 cm and with a sonographically diagnosed free myometrium margin ≥ 0.5 cm were included in the study. We selected from our institute's database a group of consecutive patients with homogeneous features of the study group, who underwent laparoscopic myomectomy without Tisseel application.


RESULTS
Fifteen women with symptomatic myoma were enrolled in the study (group A). Regarding the control group (group B), we selected a homogenous group of 15 patients with the same preoperative characteristics of the study group. Mean operative time was 47.7 min and 62.1 min, for groups A and B respectively (p < 0.05). Mean time required to achieve complete haemostasis was 195.5 s in group A and 361.8 in control group B (p < 0.0001). Mean estimated blood loss was 111.3 mL and 230 mL in groups A and B, respectively (p < 0.05). Mean hemoglobin decrease was 1.36 g/dL and 2.04 g/dL in groups A and B, respectively (p < 0.05).


CONCLUSIONS
The use of Tisseel during LM may represent a valid alternative solution for obtaining hemostasis, reducing intra- and postoperative bleeding. Furthermore, it may help the surgeon to obtain a rapid healing of the injured surfaces, probably reducing the use of electrocoagulationand traumatisms.
Department of Obstetrics and Gynecology, Campus Bio Medico University of Rome, Via Álvaro del Portillo, 200-00128 Rome, Italy. r.angioli@unicampus.it
Roberto
R
Angioli
Francesco
F
Plotti
Roberto
R
Ricciardi
Corrado
C
Terranova
Marzio Angelo
MA
Zullo
Patrizio
P
Damiani
Roberto
R
Montera
Federica
F
Guzzo
Giuseppe
G
Scaletta
Ludovico
L
Muzii
D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D016022:Case-Control Studies; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D015718:Fibrin Tissue Adhesive; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007889:Leiomyoma / Q000473:pathology / Q000601:surgery*; D007902:Length of Stay; D011183:Postoperative Complications / Q000209:etiology; D014014:Tissue Adhesives / Q000627:therapeutic use*; D047368:Tumor Burden
D015718:Fibrin Tissue Adhesive; D006490:Hemostatics; D014014:Tissue Adhesives