title: A Retrospective Analysis of the Hemostatic Effect of FloSeal in Patients Undergoing Robot-Assisted Laparoscopic Radical Prostatectomy.
abstract: BACKGROUND
  Perioperative bleeding is a potential complication of robot-assisted laparoscopic radical prostatectomy (RALP) that may worsen outcomes. The role of local hemostatic materials in RALP has not been adequately assessed. We evaluated the hemostatic impact of FloSeal (Baxter International Inc., Fremont, Calif., USA) in RALP.
  
  
  METHODS
  A retrospective analysis was performed of 392 consecutive patients with prostate cancer who underwent RALP at our institution between February 2008 and July 2014. The patients were divided into 2 consecutive homogenous groups based on the use of FloSeal. Group A included 200 patients who underwent RALP between February 2008 and May 2011, with hemostasis performed using only traditional techniques. Group B included the remaining 192 patients, who underwent RALP between June 2011 and July 2014 and received FloSeal 5 ml after traditional hemostatic methods. We compared the blood transfusion rate, the differences between immediate postoperative hemoglobin (Hb) and mean postoperative day 1 (POD1) Hb levels, difference between POD1 and least Hb levels and difference between immediate postoperative Hb and least Hb levels.
  
  
  RESULTS
  The intraoperative use of FloSeal significantly decreased the blood transfusions rate, from 8.5 to 2.1% (p = 0.004). FloSeal was also associated with significant improvements in the difference between the immediate postoperative Hb and POD1 Hb levels (p = 0.03), mean POD1 Hb and least Hb (p = 0.01) and mean immediate postoperative Hb and least Hb levels (p = 0.034).
  
  
  CONCLUSIONS
  In this study, the use of FloSeal improves hemostatic outcomes in patients undergoing RALP compared with traditional hemostatic techniques, without increase of cost.
authors.affiliation: Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Martorana
authors.forename: Ahmed
authors.initials: A
authors.lastname: Ghaith
authors.forename: Salvatore
authors.initials: S
authors.lastname: Micali
authors.forename: Giacomo Maria
authors.initials: GM
authors.lastname: Pirola
authors.forename: Cosimo
authors.initials: C
authors.lastname: De Carne
authors.forename: Francesco
authors.initials: F
authors.lastname: Fidanza
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Bianchi
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D006454:Hemoglobins / Q000032:analysis; D006470:Hemorrhage / Q000188:drug therapy; D006487:Hemostasis; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D007432:Intraoperative Period; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D013514:Surgical Procedures, Operative; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins; D006490:Hemostatics