Bovine Serum Albumin Glutaraldehyde for Completely Sutureless Laparoscopic Heminephrectomy in a Survival Porcine Model

Abstract

Introduction: Laparoscopic partial nephrectomy (LPN) has not received widespread clinical application because of its technical challenge. Bovine serum albumin glutaraldehyde (BSAG) is a hemostatic agent that is independent of the clotting cascade. We evaluated the use of BSAG as the sole agent for parenchymal and collecting system closure during LPN in a survival porcine model. Methods: Eighteen pigs underwent hilar clamping and LPN by longitudinal excision of the lateral one-third of the right kidney. The opened collecting system was covered with oxidized cellulose to prevent BSAG seepage into the urinary tract. BSAG was allowed to set for 10 or 5 minutes. Twelve animals underwent survival LPN BSAG only closure; six control pigs were acutely studied using saline. Urinary extravasation was evaluated by injection of furosemide and indigo carmine, and then evaluating the renal surface and bladder catheter drainage for dye. A subjective bleeding score was assigned after hilum unclamping. At 6 weeks, BSAG kidneys were harvested for burst pressure testing and histopathological analysis. Results: All 12 pigs survived for 6 weeks. No pigs had urinary extravasation. Mean percentage of kidney removed by weight was 19%. Mean warm ischemia time was 29 minutes. Five pigs required a second BSAG application to achieve a bleeding score of 0. Mean arterial and collecting system burst pressures were 301.8 and 322.4 mm Hg, respectively. Mean postoperative creatinine increase was 0.07 mg=dL. Conclusion: BSAG for completely sutureless LPN in a survival porcine model was feasible.

Knotless retroperitoneoscopic nephron-sparing surgery for small renal masses: Comparison of bipolar sutureless technique and barbed suture technique

“…To avoid intracorporeal suturing and additional loss of the functional renal parenchymal suturing edge, sutureless techniques have also been developed for LNSS using hemostatic agents and modalities such as glues, bolsters, lasers, and electrocoagulation. 12 , 13 , 19 , 20 However, sutureless techniques have only been reported in isolated case series or limited cases with comparison of knot-tying suture repair. 12 , 13 , 21 Although the feasibility of such techniques has been previously demonstrated in the literature, the long-term oncological outcomes, specific indications, and technical tips remain unclear.…”

Sutureless laparoscopic partial nephrectomy using fibrin gel reduces ischemia time while preserving renal function

“…Even in expert hands, rates of urine leakage and hemorrhage are not negligible (19). Despite the development of adjunctive hemostatic agents, none have proved to offer complete hemostasis by themselves (19). In this paper, we demonstrated that sutureless LPN with TISSUCOL ® can reduce warm ischemia and total operative times as well as preserve kidney function, without severe complications when compared with standard suturing LPN.…”

“…LPN is increasingly performed all over the world and constitutes a valid procedure for the management of small renal tumours, but some technical aspects still need to be improved. Even in expert hands, rates of urine leakage and hemorrhage are not negligible (19). Despite the development of adjunctive hemostatic agents, none have proved to offer complete hemostasis by themselves (19).…”

BioGlue Surgical Adhesive as a Thermal Reflector During Laparoscopic Cryoablation: Effect on Iceball Size and Ablation Zone Diameter

“…BioGlue is not a hemostatic agent and does not influence the clotting cascade; however, it has been shown in a number of human and animal studies to effectively maintain hemostasis during open or laparoscopic partial nephrectomy alone or in combination with suturing or other hemostatic agents. 6 – 8 …”