title: A Cost-Effective Delivery System for FloSeal During Endoscopic and Microscopic Brain Surgery.
abstract: OBJECTIVE
  To share our experience with a new delivery system for the flowable hemostatic matrix, FloSeal, in endoscopic and microscopic skull base surgery.
  
  
  METHODS
  We prospectively analyzed the use of FloSeal with a hemostatic delivery system in transnasal endoscopic and microscopic skull base procedures performed at the authors' institution from January 1, 2015, to June 30, 2015. In all cases the number of aliquots was noted for the entire operation, and the total number of FloSeal ampules of 5 mL was also recorded.
  
  
  RESULTS
  Our device allowed controlled application of small amounts (0.5-1 mL) of FloSeal to the site of bleeding. This controlled application resulted not only in increased visibility during its application, but it also reduced the amount of FloSeal required during the procedure. We were able to use 5-10 applications per 5-mL ampule of FloSeal within an individual procedure. No procedure required more than one 5-mL ampule of FloSeal. Therefore, the use of our device results in a reduction of costs. Prior to the use of our device, we were often only able to use 1 vial of 5 ml of material for 1 or 2 applications, especially in transnasal endoscopic procedures when working along a deep corridor.
  
  
  CONCLUSIONS
  Our results indicate that our delivery device of FlowSeal can effectively control hemostasis by applying small amounts of FlowSeal to the site of bleeding. This results in increased visibility during hemostasis and a reduction of cost.
authors.affiliation: Department of Ear, Nose & Throat Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Yves
authors.initials: Y
authors.lastname: Brand
authors.affiliation: Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Vairavan
authors.initials: V
authors.lastname: Narayanan
authors.affiliation: Department of Ear, Nose & Throat Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Narayanan
authors.initials: N
authors.lastname: Prepageran
authors.affiliation: Division of Neurosurgery, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. Electronic address: cmvwaran@gmail.com.
authors.forename: Vicknes
authors.initials: V
authors.lastname: Waran
mesh_terms: D003362:Cost-Benefit Analysis; D005781:Gelatin Sponge, Absorbable / Q000008:administration & dosage* / Q000191:economics; D006489:Hemostatic Techniques / Q000191:economics / Q000295:instrumentation; D006801:Humans; D008866:Microsurgery / Q000191:economics* / Q000295:instrumentation*; D009296:Nasal Cavity / Q000601:surgery; D044583:Neuroendoscopy / Q000191:economics* / Q000295:instrumentation*; D011446:Prospective Studies; D019291:Skull Base / Q000601:surgery*
chemical_list: C411004:FloSeal Matrix
keywords: Endoscopic skull base surgery; FloSeal; Hemostasis; Hemostatic delivery system; Microscopic skull base surgery