Renal Injury and the Application of Polysaccharide Hemospheres: A Laparoscopic Experimental Model

Abstract

Background and Purpose: Microporous polysaccharide hemospheres (MPH) are hemostatic beads engineered from purified plant starch. MPH accelerates the natural clotting cascade by concentrating clotting factors and proteins on their surface while absorbing aqueous and low molecular weight components from blood. The purpose of this study was to determine the efficacy of MPH in achieving hemostasis in the setting of laparoscopic renal injury. Materials and Methods:In four domestic pigs, 16 laparoscopic renal trocar injuries were created (8 each of 12 and 5 mm). A standard hand-assisted laparoscopic approach was used to each kidney so that two lesions per kidney were randomly created. MPH was applied to each treatment lesion with light pressure maintained for 60 seconds. Four of the 16 lesions, two each of 12 and 5 mm, were allowed to bleed as controls. Hemostasis was defined as no active bleeding or oozing. The animals were sacrificed at the conclusion of the procedure. Results: The mean time to hemostasis for the 12-mm MPH and control lesions was 196.2 Ϯ 53.3 and 372.0 Ϯ 225.6 seconds, while the average blood loss was 8.3 Ϯ 3.7 and 12.0 Ϯ 4.9 g, respectively. For the 5-mm MPH and control lesions, the average time to hemostasis was 100.2 Ϯ 24.8 and 247.0 Ϯ 134.4 seconds, while the average blood loss was 8.3 Ϯ 3.8 and 9.0 Ϯ 0.7 g, respectively. The median number of applications of the MPH for the 5-and 12-mm injuries was 1 and 2, respectively. Conclusions: MPH provided a rapid and effective means of hemostasis for laparoscopic renal parenchymal injuries in this model. Additional evaluation is warranted, however, before general application is advisable.

Evaluation of local hemostatic effect of microporous polysaccharide hemospheres products in thyroid surgery: a prospective randomized controlled study

“…Local hemostatic agents are involved in different fields clinically. They are especially used in liver resections, spleen injuries, kidney operations and orthopedic surgery frequently (14)(15)(16)20). For their experimental animal study, Humphrays et al have evaluated the use of MPH in iatrogenic spleen injuries.…”

Radiological and histopathological comparison of microporous polysaccharide hemospheres and oxidized regenerated cellulose in the rabbit brain: a study of efficacy and safety

“…Humphreys et al (7,8) have found MPH to be an effective hemostatic agent in studies performed with laparoscopic trocar injuries to the kidney and spleen in pigs. Ersoy et al have reported that MPH is effective in the hemostasis of severe femoral arterial bleeding in rats (5).…”

Hemostatic Comparison of a Polysaccharide Powder and a Gelatin Powder

“…4 Among the various classes of hemostatic agents, powdered hemostats have been widely adopted for their easeof-use; however, their efficacy has been limited to low-level bleeds. [5][6][7][8][9][10][11][12][13][14] More recently, the benefit of using powdered hemostats intraoperatively to treat low-level bleeds has been demonstrated clinically. [15][16][17][18][19][20] The two predominant materials within this class of hemostatic agents are a polysaccharide-based powder and a fibrinogen-thrombin based powder.…”