Evaluation of a hemostatic sponge (TachoSil®) for sealing of the renal collecting system in a porcine laparoscopic partial nephrectomy survival model
Date
2010
Authors
Rane A.
Rimington P.D.
Heyns C.F.
Van Der Merwe A.
Smit S.
Anderson C.
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Abstract
Objective: The objective of this study was to evaluate the efficacy of TachoSil® (Nycomed UK, Oxford, Buckinghamshire, UK), a hemostatic sponge, to seal major collecting system injuries (in addition to providing an adjunct to hemostasis) after partial nephrectomy in a porcine chronic survival model. Materials and Methods: Laparoscopic upper-pole partial nephrectomies were performed in 10 farm pigs (>40kg). After hilar clamping, an energyless incision was made at a point halfway between the hilum and the upper pole of the kidney and the collecting system was opened widely. TachoSil was applied to cover the defect; 15 to 20 minutes after the application of TachoSil, the hilar clamp was removed, hemostasis confirmed, and the pig survived. Assessment was made for hematoma and urinoma. Four weeks postoperatively, the pigs were euthanized. Ex-vivo retrograde studies were performed to assess collecting system leak. Weight, blood pressure, estimated blood loss, the weight of the partial and completion nephrectomy specimen, presence/absence of urinary leak on retrograde study, histopathologic findings, and complications were recorded. Results: All pigs survived. Mean warm ischemia time was 18 minutes, mean blood loss was 90mL, and mean resected weight was 13.7g. There was no evidence of leak on retrograde study. Histologically, nonspecific changes were noted in all specimens, which included dystrophic calcification, scarring, and areas of fibrosis at the partial nephrectomy surgical margin. Conclusion: TachoSil seals the collecting system after partial nephrectomy on a porcine chronic survival model, in addition to providing an adjunct to hemostasis. More studies, including human trials, are warranted to evaluate this observation further. © Copyright 2010, Mary Ann Liebert, Inc..
Description
Keywords
creatinine, hemoglobin, urea, animal experiment, animal model, article, bleeding, body mass, calcinosis, creatinine blood level, diastolic blood pressure, ex vivo study, fibrosis, hemoglobin blood level, hemostasis, hemostatic sponge, histopathology, kidney collecting tubule, kidney mass, kidney tubule damage, nonhuman, partial nephrectomy, peritoneal fluid, porcine laparoscopic partial nephrectomy, priority journal, radiodiagnosis, scar formation, seal, surgical approach, surgical sponge, surgical technique, systolic blood pressure, treatment outcome, urea blood level, Animals, Creatinine, Drug Combinations, Fibrinogen, Hemoglobins, Hemostasis, Surgical, Hemostatics, Kidney Tubules, Collecting, Laparoscopy, Models, Animal, Nephrectomy, Surgical Sponges, Survival Analysis, Sus scrofa, Thrombin, Urography
Citation
Journal of Endourology
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24
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