Use of gelatin matrix thrombin tissue sealant as an effective hemostatic agent during laparoscopic partial nephrectomy.

PURPOSE

We describe a technique for achieving effective hemostasis during laparoscopic partial nephrectomy using gelatin matrix thrombin tissue sealant.

MATERIALS AND METHODS

Between June 2002 and April 2003, 6 patients underwent laparoscopic partial nephrectomy using the 2-component tissue sealant. Median patient age was 59 years (range 28 to 71) and followup time ranged from 1 to 10 months (median 4.3). The tumor was at least 50% exophytic on preoperative computerized tomography and the diameter ranged from 2 to 3 cm (median 2.5). The 2-component tissue sealant, consisting of a gelatin matrix granula component and a thrombin component, was applied after resection of the tumor and before reperfusion of the kidney. Time until complete hemostasis was achieved, postoperative bleeding, estimated blood loss, warm ischemia time and length of surgery were recorded.

RESULTS

Hemostasis was immediate in all cases after application of the tissue sealant for 1 to 2 minutes to the moist resection site. The laparoscopic applicator was used to apply the material to the renal parenchyma. Hemostasis was maintained when reperfusion of the kidney was established. Estimated blood loss ranged from 50 to 350 cc (median 200), and no patient required blood transfusion. Length of surgery ranged from 89 to 230 minutes (median 189), and warm ischemia time ranged from 10 to 14 minutes (median 13). No postoperative bleeding occurred.

CONCLUSIONS

The 2-component tissue sealant provided immediate and durable hemostasis in laparoscopic partial nephrectomy. It is a safe and time sparing alternative adjunct to currently available means of achieving hemostasis. In a select patient population use of this agent may reduce warm ischemia time by circumventing the need to perform laparoscopic suturing.