title: A combination of hemostatic agents may safely replace deep medullary suture during laparoscopic partial nephrectomy in a pig model.
abstract: OBJECTIVE
  We assessed whether a combination of the fibrin tissue adhesive Tisseel® (human fibrinogen and thrombin) plus the hemostatic matrix FloSeal® (bovine derived gelatin matrix/human thrombin) could safely replace the conventional deep medullary suture without compromising outcomes.
  
  
  METHODS
  Laparoscopic mid pole and one-third partial nephrectomy was performed on the right kidney of 12 female pigs. The only difference between the 2 groups of 6 pigs each was the use of a fibrin tissue adhesive plus hemostatic matrix combination in group 2 instead of the deep medullary running suture in control group 1. Renal scans and angiograms were performed at baseline and before sacrifice at 5-week followup. Retrograde in vivo pyelogram was also done.
  
  
  RESULTS
  No significant difference was seen in operative parameters or postoperative course between the groups. Renal scans revealed a statistically insignificant trend toward greater uptake loss in group 1 and angiograms showed 3 major vessel occlusions in that group. No active bleeding was detected. Those 3 kidneys had significantly poorer postoperative uptake on renal scan than that of other kidneys (18.6% vs 39.4%, p = 0.013). Only 1 small asymptomatic pseudoaneurysm was noted in group 1. No urine leakage was found in either group. No major vessel occlusion, pseudoaneurysm or urinary complications developed in group 2.
  
  
  CONCLUSIONS
  Even after deep one-third partial nephrectomy FloSeal with concurrent Tisseel appeared sufficient to control major medullary vascular injuries and replace the deep medullary conventional suture without compromising operative outcomes. The potential advantages seen during functional and vascular examinations by decreasing the risk of unnecessary segmental vessel occlusion need further clinical evaluation.
authors.affiliation: Department of Urology, Jewish General Hospital and Departments of Radiology, Nuclear Medicine and Pathology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Ploussard
authors.affiliation: Department of Urology, Jewish General Hospital and Departments of Radiology, Nuclear Medicine and Pathology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Haddad
authors.affiliation: Department of Urology, Jewish General Hospital and Departments of Radiology, Nuclear Medicine and Pathology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Oleg
authors.initials: O
authors.lastname: Loutochin
authors.affiliation: Department of Urology, Jewish General Hospital and Departments of Radiology, Nuclear Medicine and Pathology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Rahul
authors.initials: R
authors.lastname: Bera
authors.affiliation: Department of Urology, Jewish General Hospital and Departments of Radiology, Nuclear Medicine and Pathology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Cabrera
authors.affiliation: Department of Urology, Jewish General Hospital and Departments of Radiology, Nuclear Medicine and Pathology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Nouf
authors.initials: N
authors.lastname: Malibari
authors.affiliation: Department of Urology, Jewish General Hospital and Departments of Radiology, Nuclear Medicine and Pathology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Scarlata
authors.affiliation: Department of Urology, Jewish General Hospital and Departments of Radiology, Nuclear Medicine and Pathology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Vilma
authors.initials: V
authors.lastname: Derbekyan
authors.affiliation: Department of Urology, Jewish General Hospital and Departments of Radiology, Nuclear Medicine and Pathology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Franck
authors.initials: F
authors.lastname: Bladou
authors.affiliation: Department of Urology, Jewish General Hospital and Departments of Radiology, Nuclear Medicine and Pathology, Montreal General Hospital, McGill University, Montreal, Quebec, Canada. Electronic address: manidjar@jgh.mcgill.ca.
authors.forename: Maurice
authors.initials: M
authors.lastname: Anidjar
mesh_terms: D000818:Animals; D005260:Female; D015718:Fibrin Tissue Adhesive; D005781:Gelatin Sponge, Absorbable; D006490:Hemostatics / Q000627:therapeutic use*; D010535:Laparoscopy; D023421:Models, Animal; D009392:Nephrectomy / Q000379:methods*; D013537:Sutures; D013552:Swine
chemical_list: D015718:Fibrin Tissue Adhesive; C411004:FloSeal Matrix; D006490:Hemostatics
keywords: FloSeal matrix; fibrin tissue adhesive; hemostasis; kidney; nephrectomy