Chitosan hemostatic dressing for renal parenchymal wound sealing in a porcine model: implications for laparoscopic partial nephrectomy technique.

BACKGROUND AND OBJECTIVES

This study was to evaluate the feasibility of using a novel chitosan hemostatic dressing to control hemorrhage and urinary leakage by sealing off the parenchymal wound following LPN.

METHODS

Nine heparinized domestic swine underwent bilateral laparoscopic partial nephrectomies involving either a polar or wedge resection. Estimated blood loss (EBL), hemostatic score, operative time, and adhesion score of the chitosan dressing were documented during LPN. Retrograde pyelography was performed to assess urinary leakage.

RESULTS

Of 18 procedures, complete hemostasis after deployment of the chitosan dressing was successfully achieved in 17 of them. The hemostasis score improved significantly after the deployment in both polar (P<0.001) and wedge (P=0.017) resections. The rate of successful pyelocaliceal sealing was 85% (11/13) in polar and 60% (3/5) in wedge resections. Application of a bandage in wedge resections was fraught with greater difficulties in terms of number of applications required and prolonged operative time. However, the differences between this group and polar resection were not statistically significant.

CONCLUSIONS

The chitosan hemostatic dressing is capable of being used in LPN procedures as a primary or supplemental material for controlling parenchymal hemorrhage and sealing the renal collecting system in the animal model.