Add time:09/03/2019         Source:sciencedirect.com

Introduction: To demonstrate feasibility and efficacy of commercially-available fibrin tissue sealants as a hemostatic agent and collecting system sealant during hand-assisted LPN.Methods: 15 patients underwent transperitoneal LPN for enhancing renal masses using a hand-assist device. Monopolar electrocauterization and argon beam coagulation initially was used to slow bleeding from the resection site. Through a laparoscopic applicator, Tisseel® Fibrin Sealant (Baxter Inc, Deerfield, IL) was applied to the transected bed while the surgeon’s hand maintained compression and partial hemostasis. In all cases no further hemostatic measures were required. Patients were evaluated for acute and delayed bleeding and urinary extravasation. Indigo carmine was administered intravenously (n = 5) and via ureteral catheter (n = 2) (with larger, more central tumors) to evaluate for possible urinary leak.Results: Mean age was 61 (40–82) and mean tumor size was 2.7 cm (1.5–5.0 cm). In all cases electrocauterization and argon beam followed by Tisseel® was successful in obtaining strict hemostasis of surgical bed with no intra- or post-operative bleeding. There was no evidence of intra- or post-operative urinary leak. No immediate or delayed complications were noted. Short-term outpatient follow-up (16–60 weeks) revealed no additional problems. Operating time (range)129 min (100–180)Estimated blood loss (range)173 ml (50–300)Hospital stay (range)2.7 days (2–9)Creatinine Preop (range)1.1 (0.6–2.4)Creatinine Postop (range)1.2 (0.6–3.5)Volume tisseel (range)4.8 ml (3–5)Postop bleednonePostop urine leaknoneComplications1 (arrythmia)

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