Versatility and clinical effectiveness of a synthetic sealing hemostatic patch as alternative to parenchyma suturing in laparoscopic partial nephrectomy

Abstract

Background Improvements in laparoscopic partial nephrectomy (LPN) in order to minimize perioperative warm ischemia time (WIT), complications, and consequently patient outcome are desirable. Veriset™ is a ready-to-use hemostatic patch of absorbable oxidized cellulose and hydrogel components that has earlier been implemented in vascular and hepatic surgery. We report our experience using this device in LPN. Methods Patients with a solitary malignant renal mass suspicious for renal cancer underwent LPN with either the use of Veriset™ hemostatic patch (n = 40) or conventional suture technique (n = 40). Patient characteristics, operation time and WIT, postoperative course and complications were recorded retrospectively. Tumor complexity was calculated according to the R.E.N.A.L. score. Outcome was determined according to the “trifecta” criteria (negative surgical margin, WIT < 25 min, no complications within 30 days). Results No significant differences with regard to clinical parameters and median R.E.N.A.L. score (6) were observed between both groups. Operation time (mean 127.1 min vs. 162. 8 min; p = 0.001) and WIT were both lower in the Veriset™ group (14.6 min vs. 20.6 min; p = 0.01). No differences in surgical margins (p = 0.602) and overall complication rates at 30 (p = 0.599) and 90 days (p = 0.611) postoperatively were noticed. The surgical outcome according to “trifecta” was achieved in 65% of patients using Veriset™ and in 57.5% of patients by suture closure, respectively. Conclusion The hemostatic Veriset™ patch can successfully be implemented in LPN. Handling and application appear favorable, thereby reducing operation time and WIT. The present results suggest that the device may represent an alternative to parenchyma suturing in LPN.

A Laparoscopically Compatible Rapid‐Adhesion Bioadhesive for Asymmetric Adhesion, Non‐Pressing Hemostasis, and Seamless Seal

“…Therefore, minimizing the warm ischemia time (time to clamp the renal artery) during surgery is an essential factor in maintaining organ function. [51][52][53][54][55] Linear (15 mm long and 20 mm deep) and circular (30 mm in diameter and 20 mm in depth) incisions were conducted to evaluate the hemostatic sealing effect. Compared to the suture group, the use of aAH resulted in rapid and effective hemostasis and reduced warm ischemia time and bleeding volume (Figure 7b,c; Movies S5-S7, Supporting Information).…”

The Evolution of Tumor Enucleation Partial Nephrectomy: A Comparison of Perioperative Outcomes for Sutureless Hemostatic Bandage as an Alternative to Standard Renorrhaphy

“…Some have reported the usage of hemostatic agents along the tumor bed. (12,13,14) We have previously described one such methodology that employs a combination of these in the form of a hemostatic bandage (HB). (14) The goal of utilizing a HB rather than SR is to minimize DPM when performing TE, thus allowing for truly minimally invasive renal mass resection with maximal renal function preservation.…”