Comparison of gelatine matrix-thrombin sealants used during laparoscopic partial nephrectomy

Authors


Jonathan A. Coleman, Department of Surgery/Urology, Memorial Sloan-Kettering Cancer Center, 353 East 68th Street, New York, NY 10021, USA.
e-mail: colemaj1@mskcc.org

Abstract

OBJECTIVE

To compare haemostasis and other outcomes after the use of bovine-derived or porcine-derived gelatine matrix-thrombin sealants (GMTS) in a continuous series of patients during and for 6 months after laparoscopic partial nephrectomy (LPN).

PATIENTS AND METHODS

Between October 2006 and September 2007, a consecutive sample of 35 patients with renal tumours underwent LPN by a single surgeon at a referral centre. Group 1 (25 patients) received a bovine-derived GMTS and Group 2 (10 patients) a porcine-derived GMTS. All patients underwent LPN and received one of the two GMTS, applied to the resected bed before sutured renorrhaphy over oxidized nitrocellulose bolsters. Surgical and pathology variables, including ischaemia time, blood loss, tumour size, and serum creatinine values before and after LPN, were measured. Glomerular filtration rates were calculated before and after LPN. Haemostasis was ascertained by visual examination.

RESULTS

Intraoperative haemostasis was achieved in all cases. No associated complications occurred within 3 weeks of LPN. The two groups were comparable in age (median, 65 vs 69 years, P = 0.62), gender, tumour number and location, median ischaemia time (34 vs 28 min, P = 0.148), and blood loss (200 vs 150 mL, P = 0.518). One patient in Group 1 developed a urinary fistula. One patient in Group 2 experienced self-limited gross haematuria.

CONCLUSIONS

Both the porcine- and bovine-derived agents provided acceptable haemostasis without adverse events during LPN and in the early postoperative period. Occurrences of delayed haemorrhage and urinary fistula were not likely to be related to the choice of prothrombotic agent.

Ancillary