title: The use of hemostatic agents does not prevent hemorrhagic complications of robotic partial nephrectomy.
abstract: OBJECTIVE
  To assess the impact of HA on robotic PN (RPN) outcomes.
  
  
  METHODS
  We retrospectively analyzed data from patients who underwent RPN in eight centers between 2009 and 2013. Hemorrhagic complications were defined as the occurrence of a pseudoaneurysm, arteriovenous fistula or hematoma requiring transfusion. Patients were first divided into two groups: group A (use of at least one HA) and group B (no HA used), and then into five groups to assess the impact of each HA: group 1 (no HA), group 2 (Floseal(®) only), group 3 (Surgicel(®) only), group 4 (Tachosil(®) only) and group 5 (Surgicel(®) + Floseal(®)). The impact of HA was evaluated by univariate and multivariate analysis.
  
  
  RESULTS
  Out of 515 RPN, 315 (61 %) were done using at least one HA (group A) and 200 (39 %) were done without any HA (group B). Patients in both groups had similar hemorrhagic complication rates (13 % vs. 15 %, p = 0.42) and postoperative complication rates (19 % vs. 23 %, p = 0.32). In multivariate analysis, the absence of HA was not a risk factor for hemorrhagic complications (OR 0.77, p = 0.54). When each type of HA was considered individually, none was associated with the occurrence of hemorrhagic complication either in univariate or in multivariate analysis.
  
  
  CONCLUSIONS
  In this multicenter study, the use of HA was not associated with a lower risk of hemorrhagic or global complications.
authors.affiliation: Department of Urology, University of Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France. peyronnetbenoit@hotmail.fr.
authors.forename: Benoit
authors.initials: B
authors.lastname: Peyronnet
authors.affiliation: Department of Statistics, University of Rennes, Rennes, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Oger
authors.affiliation: Department of Urology, University of Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France.
authors.forename: Zineddine
authors.initials: Z
authors.lastname: Khene
authors.affiliation: Department of Urology, University of Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France.
authors.forename: Gregory
authors.initials: G
authors.lastname: Verhoest
authors.affiliation: Department of Urology, University of Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Mathieu
authors.affiliation: Department of Urology, University of Toulouse, Toulouse, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Roumiguié
authors.affiliation: Department of Urology, University of Toulouse, Toulouse, France.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Beauval
authors.affiliation: Department of Urology, University of Tours, Tours, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Pradere
authors.affiliation: Department of Urology, Mondor Hospital, Créteil, France.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Masson-Lecomte
authors.affiliation: Department of Urology, La Pitié-Salpétrière Hospital, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Vaessen
authors.affiliation: Department of Urology, Saint-Joseph Hospital, Paris, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Baumert
authors.affiliation: Department of Urology, University of Bordeaux, Bordeaux, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Bernhard
authors.affiliation: Department of Urology, University of Toulouse, Toulouse, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Doumerc
authors.affiliation: Department of Urology, University of Nimes, Nimes, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Droupy
authors.affiliation: Department of Urology, University of Tours, Tours, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Bruyere
authors.affiliation: Department of Urology, Mondor Hospital, Créteil, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: De La Taille
authors.affiliation: Department of Urology, La Pitié-Salpétrière Hospital, Paris, France.
authors.forename: Morgan
authors.initials: M
authors.lastname: Roupret
authors.affiliation: Department of Urology, University of Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Bensalah
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000517:prevention & control; D011379:Prognosis; D012189:Retrospective Studies; D012371:Robotics; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*
chemical_list: D006490:Hemostatics
keywords: Complications; Fibrin sealant; Hemostatic agent; Outcomes; Partial nephrectomy; Robotic
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