Laparoscopic Partial Nephrectomy Using FloSeal for Hemostasis: Technique and Experiences in 102 Patients

Abstract

Laparoscopic partial nephrectomy with the use of FloSeal is a feasible and safe method for treatment of small renal masses. The technique is reproducible by surgeons who are used to complex laparoscopic procedures. Patient outcome during follow-up was comparable with data published for open standard procedures.

Bleeding during laparoscopic partial nephrectomy: Can a hemostatic matrix help to improve hemostasis?

“…Mean tumor size and mean warm ischemia time were 35+/-12 mm and 20.1+/-7 minutes, respectively. These were comparable with previous studies (4,5,17). Previous studies described an association between the depth of tumor invasion and rate of hemorrhage.…”

“…tial complications including urinary leakage and bleeding requiring transfusion (4). Since LPN was firstly reported, several techniques for tumor excision and hemostasis have been investigated to achieve a bloodless operative field for precise tumor excision is an acceptable ischemia time and with the least possible deterioration of renal function (5).…”

Current status of laparoscopic partial nephrectomy

“…The most consistently beneficial adjuncts include oxidized methylcellulose gauze (Surgicel, Ethicon, Somerville, New Jersey, USA), gelatin matrix thrombin sealants (Floseal, Baxter, Deerfield, Illinois, USA), and fibrin glues (Tisseel, Baxter) [29,30,31 ]. These findings are reflected in our current practice.…”

Surgical management of large renal tumors

“…By contrast, laparoscopic partial nephrectomy, owing to its technical difficulty, has not been widely adopted in the management of large tumors. In our recent systematic review of all manuscripts in the PubMed database including partial nephrectomy for tumors greater than 7 cm from 1999 to 2009, only 12 reported cases from nine centers were performed laparoscopically [67][68][69][70][71][72][73][74][75]. By contrast, in series ranging from 2007 to 2010, ten more cases from three centers were performed with robotic assistance (including four from our institution) [76][77][78].…”