title: [Use of TachoSil in laparoscopic enucleoresection of renal masses smaller than 4 cm: our preliminary experience of 41 cases].
abstract: BACKGROUND
  In nephron-sparing surgery the use of new and various hemostatic materials has provided a significant support in the control of intraoperative hemostasis of resection bed. Objective of this study is to demonstrate the use of hemostatic material TachoSil in laparoscopic treatment of renal masses <4 cm.
  
  
  METHODS
  41 patients underwent laparoscopic renal enucleoresection. In all patients one or more hemostatic TachoSil sponges were used, affixed to the bed of resection; we retrospectively evaluated the efficacy and safety of this technique. Transperitoneal access in 39 patients with antero-lateral mass and retroperitoneoscopic access in 2 patients with middle-posterior mass. After performing a warm ischemia, we proceeded to mass enucleoresection by cold blade, and to hemostasis control by suturing open vessels on the resection bed with "central suturing" technique. After unclamping the renal artery, one or more hemostatic sponges of TachoSil were always used (fibrinogen and human thrombin) affixed to the bed section.
  
  
  RESULTS
  No significant variations of Hb, BUN and Crs. 3 cases (6.9% of renal units) of intraoperative hemorrhage requesting blood transfusion, 2 cases (4.6% of renal units) of urinary leakage at low pressure, treated conservatively with retrograde application of ureteral stent DJ for 21 days; 2 patients underwent new laparoscopy and suture. The mean time to hemostasis, evaluated in terms of the absence of macroscopic intraoperative bleeding after the application of TachoSil, was 5.5 (3-16) minutes. Average hospital stay: 5.5 (4-11) days.
  
  
  RESULTS
  37.6 (5-84) months.
  
  
  CONCLUSIONS
  The control of hemostasis is the key problem inherent to laparoscopic technique and can be approached using hemostatic agents. Currently hemostatic agents such as TachoSil ® are used increasingly as an adjuvant agent in the control of bleeding, having an excellent application in laparoscopic renal enucleoresection, and proving safe and effective in the treatment of tumors below 4 cm.
authors.affiliation: Urologic Clinic, University of Cagliari, Cagliari - Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Fanari
authors.forename: Simona
authors.initials: S
authors.lastname: Serra
authors.forename: Andrea
authors.initials: A
authors.lastname: Corona
authors.forename: Antonello
authors.initials: A
authors.lastname: De Lisa
mesh_terms: D016063:Blood Loss, Surgical; D006490:Hemostatics; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery; D010535:Laparoscopy; D012189:Retrospective Studies
chemical_list: D006490:Hemostatics